Over recent months I have seen an unusual number of patients with endometriosis in various scar sites. The most common situation follows the performance of a caesarian section with a deposit of endometriosis within the operative field. More rarely and usually without prior surgery (including laparoscopy) the umbilicus can be affected. Interestingly I have not…
Clinical indicators to end June 2013. During this period I had major shoulder surgery and did not operate for almost 3 months. As a consequence the numbers are less than normal. There was one patient who was transfused unexpectedly. She had very substantial endometriosis and required a significant section of bowel to be removed and…
The answer seems simple. The bowel surgeon should be involved early in the process. I agree. The bowel surgeon should ideally have the seen the patient in a pre-operative consultation to discuss the planned procedure, results and potential complications. The intra-operative timing is the critical thing. If the gynaecologist has minimal surgical skills then invariably…
I have recently been asked this (or a very similar) question at a number of meetings. I have given this issue considerable thought over the years. The most common response I receive from both trainee surgeons and colleagues is that yes the surgeon should call for assistance in the event that there is unplanned damage…
Please note that the current figures to the end of 2012 should be interpreted with caution. In particular it is possible that the reoperation rates reflects a lower number than reality as some patients may have had repeat surgery of which A/Prof Cooper is not aware. Some patients may have had more than one procedure. A…
A recent consensus statement on endometriosis and infertility indicates that some women may benefit from a combination of assisted reproduction and surgery. Unfortunately the data are limited and somewhat conflicting. This is not uncommon when surgery is involved as there is inevitably a degree of operator (or surgeon) dependence. It is self-evident with diseases such…
It has been well established that oncogenic (cancer causing) strains of HPV are the cause of cancer of the cervix and in fact it could probably be considered a form of sexually transmitted disease. Over the last few years vaccines have become available (Gardasil and Cervarix) for the prevention of HPV related cervical cancer. Gardasil…
Recently one of the largest IVF groups in Australia, IVF Australia, has been sold via private equity interests into a share market floatation (Virtus Health – ASX: VRT). Whilst for many companies this may be a good idea, I have significant reservations about the subsequent quality of this company in the years to come. These…
I was recently asked to complete a survey into the “pain of laparoscopic surgery”. The authors were interested in the pain experienced by surgeons who perform laparoscopic surgery. This started me thinking about a subject that I have often discussed with trainee surgeons under my care; that is the ergonomics of laparoscopic surgery. For those…
Our new paper just published on this topic. Management of deeply infiltrating endometriosis involving the rectum. CE Koh, K Juszczyk, MJ Cooper, and MJ Solomon Dis Colon Rectum, September 1, 2012; 55(9): 925-31. BACKGROUND: Rectal endometriosis can cause debilitating symptoms. Rectal resection in this setting has been shown to improve symptoms; however, there remain…