Intensive Master in Basic and Advanced Laparoscopic Surgical Anatomy of Female Pelvis and Techniques
Dear friends,
we invite you to join us at the “1st ISSA International, Hands-On Intensive Master in Basic and Advanced Laparoscopic Surgical Anatomy of the Female Pelvis and Techniques” in collaboration with the AAGL (Elevating Gynecologic Surgery).
We are delighted to welcome you in the beautiful city of Verona, in the north-eastern part of Italy, lying on the borders of the beautiful Garda lake.
Verona is one of the most outstanding cities in the world, with more of two thousand years of history. Considered as the city of love, it is the place where William Shakespeare set his masterpiece “Romeo and Juliet”. This little gem of a city of art and history shines for the presence of many beautiful ancient monuments and buildings, among which the Arena, a roman coliseum hosting a very famous summer Opera festival. The neck of the city is covered by a scarf of beautiful hills and valleys overcrowded by grapevine trees, defining the famous wine area called “Valpolicella”, producing some of the finest type of wines known all over the world, such as the Amarone, Ripasso, Valpolicella and Recioto.
This four-days hands-on intensive course is addressed to pelvic surgeons interested in enjoying the cadaveric model to deepen their knowledge in surgical anatomy, which is traditionally the golden rule of the ISSA School. The course is designed for gynecologists, general surgeons, urologists and pelvic surgeons who perform basic, intermediate and difficult laparoscopic surgery. It will provide a step-by-step surgical approach to the pelvic viscera and to the different surgically-treatable diseases affecting them, with a particular focus on benign disease, deep infiltrating endometriosis and gynecologic malignancies. A common distortion and infiltration of the pelvic organs may be encountered not only in a gynecological cancer and deep infiltrating endometriosis, but also in simple procedures and the only safe way to restore anatomy and achieve radicality is to follow simple anatomical rules.
Each day, live-surgery sessions will alternate with cadaveric hands-on dissections.
Your “spectator” part of the course will be a sparkling mix of: theoretical presentations and keynote lectures brought by an international faculty of stakeholders and key-opinion leaders, keynote cadaveric dissections held by Dr. Marcello Ceccaroni and Dr. Shailesh Puntambekar, live-surgery broadcasted to the congress Venue from the “IRCCS Sacro Cuore Don Calabria Hospital” operating rooms and performed by Dr. Ceccaroni and Dr. Puntambekar and other Masters of surgery, together with their assistants with the help of a multi-disciplinary team.
For the “live-surgery” sessions, which will be casted every morning, a large set of surgical operations for different pathologies will be shown, from the simple laparoscopic hysterectomy to the “Pune Technique” radical hysterectomy and the “Negrar Method” for eradication of deep infiltrating endometriosis with parametrial and rectal resection. Particular focus will be put on the correct employment of the nerve-sparing principles both, in oncologic and benign disease, and on the correct use of energy and techniques. In fact, all the dissection will be performed under the eye of a “neurogynecologic” approach.
The theoretical lessons will firstly focus on anatomical principles and then on the single pathologies and their surgical treatment options with wide use of surgical movies. In addition, a room will be avaiable for pre-recorded and on-demand surgical videos and a permanent “Continuous Video Session”.
The keynote cadaveric dissections will introduce and give you a “syllabus” for the following hands-on dissection, showing how to find out and dissect the pelvic spaces on these peculiar and very realistic specimens.
Your “actor” part of the course, which will be performed with the help of the Faculty tutors, will provide a hands-on tutorial on cadaveric specimen, using laparoscopic instrumentation and 3D technology. Main learning objectives will be: to recognize the anatomical landmarks and major pelvic structures pertinent to gynecologic laparoscopy and retroperitoneal dissection, to apply laparoscopic surgical techniques to enter and expose the avascular spaces of the pelvis, parametrial ligaments, nerves and pelvic vascular system and their relations with the ureter and intraperitoneal structures, to illustrate the step-by step dissection of the pelvic viscera and pelvic-nerves related to the different gynecological procedures and nerve-sparing techniques for gynecologic cancers and endometriosis surgery.
The last day of the course will provide a cadaveric hands-on masterclass on laparoscopic suturing techniques, introduced by theoretical lessons showing the basic principles of endoscopic suturing and knotting. A pelvic trainer session will follow where the candidates will be guided by the tutors in suturing simple (i.e. vaginal cuff, myometrial defect after myomectomy) and complex (i.e. vescical and ureteral resections and injuries, bowel injuries, vascular injuries) wounds on the cadaveric specimen.
A social dinner in an ancient and fascinating venue will be offered to all of the participants in order to give a taste of the Italian food, history and lifestyle.
We look forward to sharing this inspiring, memorable and highly educational artistic, musical, anatomical and surgical experience with you!
We wait for you and remember: If you love someone bring them to Verona!
Marcello Ceccaroni
Course Director
ISSA President
Shailesh P. Puntambekar
Course Director
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Intensive Master in Basic and Advanced Laparoscopic Surgical Anatomy of Female Pelvis and Techniques
The course consists of theoretical and keynote lectures, video sessions, live surgery, basic and advanced cadaver laparoscopic dissections and a cadaveric hands-on masterclass on laparoscopic suturing techniques, which are going to be performed directly by the participant, under the supervision of the tutor.
MORNING
08.30 Course presentation and welcome M. Ceccaroni, S. Puntambekar
09.00 Keynote Lecture: How to become a sailor and not a pirate: Cartography of retroperitoneal anatomy for a safe laparoscopic navigation S. Uccella
09.30-13.00 Live Surgery from IRCCS Sacro Cuore Don Calabria Hospital Surgeons: M. Ceccaroni, S. Puntambekar, D. Mautone, R. Clarizia Chairs: S. Uccella, F. Bruni, M. Telang
13.00-14.00 Lunch
Lunchtime lectures Chair: M. Piccegna
13.00 How to make it easy: Step-by-step laparoscopic surgical anatomy and different strategies of hysterectomy for benign disease F. Bruni
13.30 How to make it easier: Laparoscopic hysterectomy for uterine adenomyosis and large uteri: when anatomy and ergonomy counts G. Roviglione
AFTERNOON
14.00-18.40 Lectures Chairs: R. Clarizia, G. Roviglione, S. Cosma
14.00 The bricks in the wall: Abdominal wall anatomy for minimally-invasive accesses M. Telang
14.25 The adnexal surgery dilemma: Reproductive surgical anatomy. Surgery of the ovaries and tubes is not that easy A. Stepniewska
14.50 Deep diving in the pelvic retroperitoneal seas: Laparoscopic surgical anatomy of pelvic lymphadenectomy A. Puppo
15.15 Diving and sailing along the big vessels: Laparoscopic surgical anatomy of para-aortic lymphadenectomy V. Gallotta
15.40 The other side of the moon: Laparoscopic surgical steps and anatomy of extra peritoneal lymphadenectomy J. De Santiago Garcia
16.05 Onco-mimetic surgical behaviors: Laparoscopic surgical anatomy of eradication of deep endometriosis and pelvic malignancies with rectal and parametrial resection according to the nerve-sparing technique: the “Negrar Method” R. Clarizia
16.30 Using retroperitoneal ligation of uterine artery in difficult situations in benign surgery P. Trivedi
16.55 Coffee Break
17.10 Keynote Lecture: “How to unfreeze a frozen pelvis”: Different surgical approaches to visceral and somatic nerves, retroperitoneum and upper abdomen for ultra-radical procedures M. Ceccaroni
17.55 Keynote Lecture: Laparoscopic surgical anatomy in different types of radical hysterectomy for endometrial and cervical cancer according to the “Pune Technique” S. Puntambekar
18.40 Discussion, Adjourn and Conclusion
MORNING
Coffee and water station will be available during the whole day
08.30 – 09.00 Keynote Lecture: Neuropelveology: a new groundbreaking area in Medicine V. Chiantera
09.00-12.45 Live Surgery from IRCCS Sacro Cuore Don Calabria Hospital Surgeons: M. Ceccaroni, S. Puntambekar, F. Bruni, R. Clarizia, A. Puppo Chairs: P.N. Barri Soldevila, N. Barbany Freixa, D. Mautone
Live Surgery from the Malzoni Medical Centre Avellino Surgeon: M. Malzoni
12.45-14.00 Lunch
Lunchtime lectures Chair: G. Vizzielli
12.45 – 13.10 “Uncommon sites” endometriosis treatment (abdominal wall, groin, diaphragm, pleura, pericardium) G. Roviglione, L. Garriboli
13.10 – 13.35 The front doors: Surgical anatomy of the posterior compartment for gynecological procedures (Douglas pouch, recto-vaginal septum, utero-sacral ligaments, posterior broad ligaments): digging under the surface to find landmarks R. Clarizia
13.35-14.00 The back doors: Surgical anatomy of the anterior compartment for gynecological procedures: urinary tract surgery means parametrial surgery D. Mautone
AFTERNOON
14.00-18.30 Permanent Satellite Video Session (Satellite Room) G. Mantovani, M. Manzone, A. Finelli
14.00-15.00 When death helps life: Pre-recorded Keynote video cadaveric dissection
15.00-18.30 Death for life marathon: Hands-on cadaveric dissection Supervising tutors: M. Ceccaroni, S. Puntambekar – Tutors: All faculty
DISSECTION TOPICS
Topographic and Surgical Anatomy of the Anterior Abdominal Wall:
Vessels, muscles and sheaths, nerves, laparotomic and laparoscopic accesses.
Topographic and Surgical Anatomy of the Upper Abdomen
(supramesocolic space): embryologic tips, diaphragm, liver, gallbladder, pancreas, spleen, blood and lymphatic vessels, nerves, sheaths, spaces, connectives, retroperitoneum. Surgical anatomy of diaphragm and of hepatic ligaments and segments. Left and right bowel mobilization for colo-rectal radical surgery.
Topographic and Surgical Anatomy of the Lower Abdomen
(infra-mesocolic space): embryologic tips, kidneys, adrenal glands, ureters, small bowel, colon-rectum, blood and lymphatic vessels, nerves, sheaths, spaces, connectives, retroperitoneum.
Radical abdominal and bowel surgery.
LEARNING OBJECTIVES
– Pneumoperitoneum induction and trocar placement with different accesses techniques (Veress needle, umbilical access, Palmer access, open laparoscopy, visual trocar, direct access).
– Anterior abdominal wall complications prevention and fixing
– Upper abdomen exploration and visceral topography
– Upper abdomen adhesiolysis
– Laparoscopic adhesiolysis, partial cecum and sigmoid mobilization
– Accurate wide abdomino-pelvic inspection (such as in oncological diagnostic procedures)
– Accurate description of the abdomino-pelvic anatomy (ligaments, organs, viscera, peritoneal folds, etc.)
– Cutting of the round ligament
– Opening of the lateral paravesical space (PVS), identification of the landmarks (pelvic floor, umbilical artery and ligament, obturator artery, vein and nerve, ischio-pubic branch, pelvic floor, etc.)
– Opening of the medial paravesical space (PVS), identification of the landmarks (vesico-uterine ligaments, bladder pillars, bladder, etc.)
– Opening of the Medial pararectal space and identification of all of the landmarks
– Opening of the lateral pararectal space and identification of all of the landmarks
– Isolation and identification of the meso-ureter, following its course up to the ureteral tunnel
– Isolation and identification of the uterine artery and its relationships with the ureter
– Isolation and identification of Cardinal ligament and Lateral Parametrium
– Opening of the ilio-lumbar space and description of all of the landmarks (psoas muscle, genito-femoral nerve, obturator nerve, lumbo-sacral trunk, external iliac vessels, etc.)
– Isolation and skeletonization of hypogastric artery and its branches
– Tips and tricks for a safe identification and ligation of hypogastric artery
– Opening of the retropubic Retzius’-space, mobilization of the bladder and identification of all of the landmarks
– Isolation and identification of anterior parametrium and vesico-uterine ligaments
– Opening of the retrorectal and pre-sacral space and identification of all of the landmarks
– Identification and description of hypogastric nerves and visceral innervation
– Isolation and identification of posterior parametrium, recto-vaginal ligaments and rectal wings
– Full mobilization of the cecum and of the sigmoid with identification of all the landmarks
– Intestinal mobilization, liver and spleen mobilization, Cattel-Valdoni, Mattox, Jinnai and Kocher manoeuvres
– Isolation and skeletonization of right IP ligament up to its confluence in Cava (accurate dissection and skeletonization of the vessels: it’s a very good training even for beginners)
– Isolation and skeletonization of left IP ligament up to its confluence in left Renal Vein (accurate dissection and skeletonization of the vessels: it’s a very good training even for beginners)
– Surgical anatomy of appendectomy
– Surgical anatomy of cholecystectomy,
– Surgical anatomy for adnexal surgery: ovarian cysts approaches, tubal surgery, salpingo-oophorectomy
– Surgical anatomy for simple hysterectomy
– Surgical anatomy for large uteri hysterectomy
18.30 Discussion, Adjourn and Conclusion
MORNING
Coffee and water station will be available during the whole day
8.30 – 9.00 Keynote Lecture: Surgical anatomy of laparoscopic liver mobilization and diaphragmatic exposition for infiltrative diseases G. Ferron
9.00 – 13.00 Live Surgery from IRCCS Sacro Cuore Don Calabria Hospital Surgeons: M. Ceccaroni, S. Puntambekar, F. Bruni, V. Chiantera, G. Roviglione – Chairs: V. Gallotta, G. Ferron, S. Gueli Alletti
13.00-14.00 Lunch
Lunchtime lectures Chairs: M. Ceccarello
13.00 I’ll tell you a secret: Tips and tricks for a safe and anatomical laparoscopic myomectomy P. N. Barri Soldevila
13.30 I’ll tell you a secret: Tips and tricks for a safe and anatomical promonto-fixation and surgery for pelvic floor defects A. Ercoli
AFTERNOON
14.00 – 17.00 Satellite Live-Surgery from Pittsburgh Medical Center at Magee Womens Hospital, Pittsburgh, PA, USA Surgeon: T.T.M. Lee – Magee Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh USA Chairs: R. Clarizia, M. Ceccarello
14.00 – 18.30 Permanent Satellite Video Session (Satellite Room) G. Mantovani, M. Manzone, A. Finelli
14.00 – 18.30 Death for life marathon: Hands-on cadaveric dissection Supervising tutors: M. Ceccaroni, S. Puntambekar – Tutors: All the faculty
DISSECTION TOPICS
Anatomy and surgical techniques in pelvic radical and ultra-radical surgery
Deep infiltrating endometriosis, cervical cancer, endometrial cancer, ovarian cancer, colo-rectal cancer (different types of radical hysterectomy, radical oophorectomy according to Hudson and Delle Piane, pelvectomy), inguinal anatomy, anatomy of the Scarpa’s triangle. Diaphragmatic surgery.
Liver surgery.
Nerve-sparing laparoscopic pelvic surgical procedures and techniques
Nerve-sparing radical hysterectomy, nerve sparing rectal resection for deep endometriosis.
LEARNING OBJECTIVES
– Surgical anatomy of ureter for endometriosis eradication
– Surgical anatomy of pelvic vessels
– Surgical anatomy of the bladder in endometriosis surgery
– Inferior mesenteric vessels ligation
– Splenectomy and spleno-pancreasectomy
– Adrenalectomy
– Intestinal lesion repairing
– Colo-rectal nerve-sparing resection
– Vascular suturing techniques, artery and vein anastomoses techniques, graft anastomosis technique
– Parametrial preparation according to different types of radical hysterectomy
– Ureteral and bladder resection
– Surgical approaches for ovarian, endometrial and cervical cancer
– Inguinal lymphadenectomy
– Sacral promontorium exposition
– Hypogastric vessels ligation
– Uterine artery ligation and different steps for hysterectomy according to different classes of radicality
– Obturator nerve isolation and iatrogenic lesion repairing
– Infracolic omentectomy with identification of all the landmarks
– Gastrocolic omentectomy with identification of all the landmarks
– Diaphragmatic exposition and liver mobilization
– Diaphragmatic stripping, resection and suturing
– Hepatic surgery techniques
– Tips and tricks for approaching the visceral and somatic nerves in the pelvis
– Tips and tricks for a nerve-sparing radical pelvic surgery
– Pelvic lymphadenectomy with medial approach (accurate dissection and skeletonization of the vessels: very good training even for beginners)
– Pelvic lymphadenectomy with lateral approach
– Pre-sacral lymphadenectomy with identification of all the landmarks
– Para-caval and pre-caval lymphadenectomy
– Intercavo-aortic lymphadenectomy
– Para-aortic and pre-aortic lymphadenectomy
– Uretero-neocystostomy
– Nephrectomy
– Anterior pelvectomy
– Posterior pelvectomy
– Total pelvectomy
18.30 Discussion, Adjourn and Conclusion
20.30 Social Dinner
MORNING
Coffee and water station will be available during the whole day
8.30 – 13.00 Live-Surgery from IRCCS Sacro Cuore Don Calabria Hospital Surgeons: M. Ceccaroni, S. Puntambekar, P. N. Soldevila, D. Mautone, S. Uccella, G. Roviglione – Chairs: F. Bruni, R. Clarizia, N. Barbany Freixa
13.00-14.00 Lunch
Lunchtime lectures Chair: R. Clarizia
13.00 – 14.00 Lunchtime suturing video session D. Mautone, F. Campolo
AFTERNOON
14.00 – 18.30 Permanent Satellite Video Session (Satellite Room) G. Mantovani, M. Manzone, A. Finelli
14.00 – 18.30 Hands-on laparoscopic suturing masterclass Supervising tutors: M. Ceccaroni, S. Puntambekar, F. Campolo, D. Mautone – Tutors: All the faculty
Pelvic Trainer: stitching and knotting on models
Video session:
– How to load the needle
– Running Sutures
– Intracorporeal Knotting Techniques
– Knotting Alternative Techniques
– Rules & Tips for the Extracorporeal Technique
Death for life marathon: Hands-on suturing masterclass on cadaveric specimen
TOPICS AND LEARNING OBJECTIVES
– Needle mounting and holding
– The choice of different sutures
– Intra-corporeal knotting techniques
– Extracorporeal knotting
– Vaginal suturing for hysterectomy
– Vaginal suturing after vaginal resection
– Uterine suturing for myomectomy
– Bladder suturing after bladder injuries
– Bladder suturing after bladder resection
– Intestinal suturing after intestinal injuries
– Intestinal suturing after bowel shaving
– Vascular suturing after vascular injuries
– Diaphragmatic suturing after resection
18.30 Discussion, Adjourn and Conclusion
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