Laparoscopy Today

Presentation of the 2008 SLS Excel Award, 17th SLS Annual Meeting and Endo Expo 2008, September 17–20, 2008

September 18, 2008

Chicago, Illinois, USA

SLS' 2008 Excel Award recipient was presented to Harrith M. Hasson, MD, who lectured on "Evaluating Surgical Performance."

“I knew Harrith before I knew Harrith,” said Dr. Charles Koh in his introduction of Dr. Harrith Hasson, the 2008 Excel Award recipient. “He is humble but has an ever-searching brain.”

Attending the award ceremony, to Dr. Hasson’s surprise and delight, were “Harry’s Angels,” a group of devoted employees who worked by his side for many years while he was in Chicago.

Dr. Hasson has many firsts. He was the first to perform the open laparoscopy technique, which was named after him, the Hasson Technique, along with the instruments to be used during the procedure. His experience using this new technique was published in the Journal of Reproductive Medicine in 1974. He was the first to design a simulator for training surgeons, he has 52 patents for medical devices, and he has numerous publications and awards to his credit. RealSim Systems, founded by Hasson in 2004, develops laparoscopic simulators, which are considered better than virtual training simulators.

“To perform laparoscopic surgery,” said Hasson, “certain abilities are required. These include the ability to operate on a 3-D object from a 2-D image and the ability to develop psychomotor hand-eye coordination.” His current goal is to bring about a paradigm shift in the assessment and training of surgeons. He hopes the current system of using subjective measures to assess skills will be replaced by the use of objective measures for this purpose. With the use of simulators, skills can be objectively tested. “Some things are not teachable,” said Dr. Hasson. Each person is born with a certain skill level. Some have greater skill than others. Through the use of simulators, each person can practice until his or her particular skill is developed to its highest level. 

by Ann Conti Morcos, MA, ELS

www.Laparoscopy.org  The Laparoscopic Surgery Information Source

SLS Evening with Faculty, 17th SLS Annual Meeting and Endo Expo 2008, September 17–20, 2008

September 18, 2008

The Adler Planetarium and Astronomy Museum, Chicago, Illinois, USA

The magnificent Chicago skyline welcomed SLS faculty and guests to an incredible evening in extreme environments–soaring in space above the Earth and swimming in the depths of the Earth’s ocean.

Sailboats sliced through Lake Michigan’s calm waters as SLS faculty and guests arrived for this special event at the Adler Planetarium and Astronomy Museum, which sits along Lake Michigan near Soldier Field and the Chicago Field Museum. It was founded in 1930 by Max Adler and contains astronomical and planetarium artifacts dating from the 12th through the 20th centuries. It is the largest of its kind in the western hemisphere.

After touring the museum, faculty and guests enjoyed food, fun, and conversations with fellow SLS members and guests, then were awed by footage of space travel and the International Space Station and surgery in the depths of the ocean.

Imagine doing surgery from any position even while floating upside down or having a few-second delay from the time you move the arm of a surgical robot to the time the instrument performs the action in the patient. These are among the experiences that Dave R. Williams, MD, shared during his talk “Telerobotic Surgery in Extreme Environments.” Williams, a Canadian native, has made 2 space flights to the International Space Station, one in 1998 the other in 2007, and 3 space walks. He has also participated in the NEEMO missions in the ocean and is the first Canadian to do both. 

Today’s astronaut, said Williams, need not be a person with a military background. Today’s astronauts come from various fields, including medicine, education, and science. Surgery is being attempted in space as a way of preparing for a future flight to Mars, which will require three years of space travel. However, as in military deployments, medical care may be provided in space by a team member who is not a physician but who has training in wilderness medicine. Thus far, no humans have been operated on in space, only animals such as rats. During space travel, astronauts practice minimally invasive exercises on each other. Zero gravity causes changes to the human body, resulting in physiological challenges. Astronauts must learn ways to cope with these physiological changes before successful surgery can be performed in space. Astronauts are trying to understand the human body parts, including blood, which are altered in space. Other challenges include working in microgravity where everything must be restrained or it will float around, so astronauts must learn to work with instruments that are tied down in some way or that float around. By 2020, it is hoped that man will be able to return to the moon. One NEEMO mission included robotic telesurgery in which a physician in Canada performed a medical exercise using a simulator housed in a NEEMO facility deep underwater. This exercise provided practice in telesurgery, which may become necessary during long flights in outer space. As mankind advances toward exploring the universe, it is important to be able to provide medical care to astronauts, just as it is necessary to care for wounded soldiers in far off countries. Telesurgery with the use of robots and telementoring in extreme environments are vital for safety in future space exploration.

by Ann Conti Morcos, MA, ELS

Opening Ceremony, 17th SLS Annual Meeting and Endo Expo 2008, September 17–20, 2008

September 17, 2008

Chicago, Illinois, USA

The biggest thing “This Week in Chicago” was the SLS Annual Meeting and Endo Expo!

Opening the conference were the Blues Brothers who set the tone for an enjoyable evening with jokes and songs from days gone by that everyone could sing-along with. Dr. Paul Wetter announced several significant SLS achievements over the past year to the physicians from Korea, Turkey, Germany, the United Kingdom, Italy, Australia, Portugal, Japan, France, Singapore, China, Venezuela, India, Pakistan, Czech Republic, Iran, Mexico, Canada, and other countries, and almost every state in the Union who attended the conference. Kudos are in order for the following:

·      JSLS, Journal of the Society of Laparoendoscopic Surgeons ranked in the top 100 downloads on the Ingenta Web site 6 times over the past year.

·      The JSLS table of contents ranked 9 of 10,000 downloads on the Ingenta site.

·      Prevention and Management of Laparoendoscopic Surgical Complications, 1st edition, is now available free online in Spanish. This translation is the result of the joint effort of SLS and ALACE (la Asociación Latinoamericana de Cirugía Endoscópica) and the work of Dr. Gustavo Stingel of SLS and Dr. Roberto Gallardo, President of ALACE. Prevention and Management has now been translated into Chinese, Portuguese, and Spanish.

·      The History of Endoscopy by Dr. Camran Nezhat was recently published at http://laparoscopy.blogs.com/endoscopyhistory/. This is an open access publication, which is envisioned to operate like Wikipedia, with minimally invasive surgeons from around the world submitting information, photos, and their experiences for review and addition to the book. The book is available through RSS feed for downloading to your cell phone or other device. Dr. Nezhat had a fellowship to research and write this book, which took him 2 years.

·      Laparoscopy Today has been available online for 2 years. The latest issue is the first “green” issue, which can be downloaded as a PDF.

Following these announcements awards for the best scientific papers, videos, and poster presentations were handed out, and Dr. William E. Kelley, Jr., SLS President, gave his address. The Honorary Chairs for this year’s conference were Makote Hashizume, MD, PhD, of Japan who shared his expertise on image-guided minimally invasive robot-assisted surgery, and Errico Zupi, MD, of Italy who discussed NOTES. Rounding out the evening was a special talk by James “Butch” Rosser, Jr., MD, of “Top Gun” fame who shared his inspiring thoughts about virtual learning. With that, conference attendees followed the Blues Brothers into the welcome reception and opening of the exhibit hall, which marked the official opening of the conference.

by Ann Conti Morcos, MA, ELS

Poster Town Hall

FROM THE 16TH SLS ANNUAL MEETING AND ENDO EXPO 2007, SAN FRANCISCO, CALIFORNIA, SEPTEMBER 5–8, 2007

A great new approach to poster presentations was launched at the 16th SLS Annual Meeting and Endo Expo 2007. It is called the Poster Town Hall. From all the posters presented, the “Best Poster” was chosen in general surgery, urology, gynecology, and multispecialty. Recipients of these Best Poster awards re-presented there work in five minute oral slide presentations. The “Best of the Best” poster was chosen, and the authors received a $500 prize. This year’s “Best of the Best” poster award went to “Does Purchasing a da Vinci Robot Make Sense for a Mature Laparoscopic Prostatectomy Program?” by Peter L. Steinberg, MD, Paul A. Mergurian, MD, John A. Heaney, MB, William Bihrle, III, MD, John D. Seigne, MB.

Best Poster—Multispecialty
Development of a Method for the Consistent Creation of Experimental Pelvic Adhesions in a Swine Model

Submitted by Bradford W. Fenton, MD, PhD, Michelle Evancho-Chapman, James Fanning, DO

An animal model is lacking that allows for an easily replicable wound that produces consistent pelvic adhesions for use in adhesion prevention research. In this study using a swine model, a low-powered longitudinal electrocautery injury to the pelvic sidewall adjacent to a similar injury of the uterus and held in place with retention sutures for 14 days consistently generated dense, but anatomically delimited, adhesions between the pelvic sidewall and uterine horn. This technique can provide the basis for further quantitative analysis of adhesion prevention techniques.

Best Poster—General Surgery
Does Purchasing a da Vinci Robot Make Sense for a Mature Laparoscopic Prostatectomy Program?

Submitted by Peter L. Steinberg, MD, Paul A. Mergurian, MD, John A. Heaney, MB, William Bihrle, III, MD, John D. Seigne, MB

Robotic-assisted prostatectomy (RAP) and laparoscopic prostatectomy (LRP) are equivalent in terms of outcomes. We performed a cost benefit analysis of obtaining a da Vinci robot to provide recommendations about transitioning from LRP to RAP. We found that if a center does a high volume of prostatectomies, then converting to RAP is feasible and profits can be maintained. However, for low-volume programs (<25 cases/year), the high cost of the robot makes if not fiscally viable. If a robot is donated, costs are less and allow for reasonable revenues without drastic increases in caseloads. Because LRP and RAP outcomes are comparable, hospitals should weigh the market forces against the intangible benefits of robotics to determine whether such benefits outweigh the expenses of owning and operating a robot.

Best Poster—Gynecology
A Case of Large Urachal Cyst Treated by Laparoscopic-assisted Surgery

Submitted by Takashi Yamada, MD, Hiroshi Mori, MD

Laparotomy is the usual treatment of symptomatic urachal cysts, which develop from persistent urachal remnants. Our patient had a clinical diagnosis of an ovarian cyst. However, upon laparoscopic surgery for its removal, no ovarian cyst was found. Through the laparoscope, a cystic mass was seen hanging from the anterior abdominal wall. Using laparoscopic assistance, the cystic fluid and the tissue were removed. A histology study indicated that this was a urachal cyst. Thus, laparoscopic-assistance was used both for removal of this large type of cyst as well as for its diagnosis.

Laparoscopy Updates

From the 16th SLS Annual Meeting and Endo Expo 2007, San Francisco, California, September 5–8, 2007

Laparoscopy updates are presented at SLS Annual Meetings by members of SLS’ Special Interest Group (SIG) Committees. SIG committee members support the educational mission of SLS through prearation of the updates as well as preparing “Patient Information Pages. ” Learn more at www.SLS.org.

Update Urology
The Winners and Losers: Urologic Update in Minimally Invasive Surgery 2007

Presented by Howard Winfield, MD

Over the past 15 years, almost every type of abdominal or pelvic surgery has been tried laparoscopically or robotically. Which of these procedures have proven to be better than the open procedure (the winners) and which have proven to be worse (the losers)? Laparoscopic radical, simple and donor nephrectomy and laparoscopic adrenalectomy are winners and have become the gold standard. Patients have a better postoperative outcome and the end points of cancer cure or removal of the disease organ are equal to that of open surgery.  Robotic-assisted radical prostatectomy for prostate cancer is a winner, being as good as or better than the open procedure in terms of blood loss, continence, hospitalization, and convalescence.  In 2007, it is estimated that over 50% of radical prostatectomies will be done robotically.  Some losers include laparoscopic partial nephrectomy, radical cystectomy and urinary diversion, ureterolysis for retroperitoneal fibrosis, and retroperitoneal lymph node dissection for testis tumor, which have not been shown to be better than the open procedures. Laparoscopic varix ligation for treatment of varicoceles and bladder neck suspension for female stress urinary incontinence are not as good as microsurgical varix ligation and transvaginal bladder suspension. As for pediatric laparoscopic and robotic procedures, they are still developing and have little strong support among practitioners.

Update Abdominal and Pelvic Pain and Adhesions
Does Adhesion Cause Pain? Should We Perform Adhesiolysis for Treatment of
Pelvic Pain?

Presented by Maurice K. Chung, MD

Adhesions, fibrous tissues connecting organs that are normally separated, cause infertility, chronic pelvic pain, small bowel obstruction, and intraoperative complications, all of which generally lead to subsequent surgery. Pelvic adhesions are very common after pelvic surgery. If adhesions to the peritoneum are mobile, pain is more frequent, but when adhesions are fixed, no pain is experienced. Pelvic adhesions exist in 15% to 45% of patients with chronic pelvic pain; however they may or may not be the cause of the pain. Treatment of adhesions is controversial because surgery may cause the formation of more adhesions. Adhesiolysis decreases pain, but many patients experience a recurrence over time. In a study of 105 patients with previous abdominal surgeries, 50% (52) had adhesions on second look, and 52% (27) had pelvic pain. Twenty of the 27, however, had a positive potassium sensitivity test (74%) and 2 had a positive cystoscopy/ hydrodistention (7.4%), indicating painful bladder syndrome. After treatment for IC/PBS, the pain stopped or decreased by at least 50%.

Update Hysterectomy
The Role of Laparoscopy and Robotics in Hysterectomy

Presented by Ceana Nezhat, MD

The rate of hysterectomies performed has remained stable for the past 2 decades, but the number of laparoscopic and laparoscopic-assisted vaginal hysterectomies has doubled. Laparoscopy is being used more frequently in complicated hysterectomies in patients with malignancy. Instruments are being improved that will decrease OR time, reduce morbidity and patient recovery time, and will advance minimally invasive hysterectomies. With progress in radio frequency technology, advances are being made in vessel sealing devices. These new devices allow quick sealing of uterine vessels and ligaments with little tissue damage and charring, thus decreasing OR time, blood loss, and recovery time. Robotic surgery has made laparoscopy even more advantageous because of the improved physical comfort for the surgeon, better visualization with 3-D images and magnification, and instrumentation that corrects for hand tremor and allows better access. Some drawbacks to robotic surgery, however, are expensive equipment, lack of tactile feedback for the surgeon, and increased preparation time and staff training.

THE BEST PAPERS

FROM THE 16th SLS ANNUAL MEETING AND ENDO EXPO 2007, SAN FRANCISCO, CALIFORNIA, SEPTEMBER 5–8, 2007

Best Scientific Paper—Gynecology
Staging of Advanced Ovarian Cancers: Interest in Thoracoscopy

Submitted by Anne-Sophie Bats, MD, Sandra Cohen-Mouly, MD, Reda Souilamas, MD, Cherazade Bensaid, MD, Marie Junger, MD, Florence Larousserie, MD, Fabrice Leceru, MD, PhD

Thoracoscopy can improve the staging of ovarian cancer and allow the changing of therapeutic management of patients with advanced ovarian cancer associated with pleural effusion.  Eight thoracoscopies were performed on the right side and 3 on the left side. One of them was stopped for refractory hypoxemia. Pleural effusion recurred in only one case. Of these 11 patients, 4 women had pleural metastases diagnosed by thoracoscopy, whereas the thoracic CT scan was normal; 3 patients were classified in the 4th stage of cancer because of pleural effusion, but thoracoscopy confirmed the diagnosis due to negative biopsies. In 2 patients, the pleural disease was more severe than was the abdominal extension. These women were recommended for chemotherapy.

Best Scientific Paper—Urology
Comparative Review of Laparoscopic and Robotic-assisted Radical Cystectomy with Ileal Conduit Urinary Diversion

Submitted Matthew N. Simmons MD, PhD, Inderbir S. Gill, MD, MCh

No uniform reporting methods are available to compare outcomes data for laparoscopic partial nephrectomy (LPN); therefore, outcomes data are limited.  We used a standardized complications reporting system to analyze complications in a contemporary cohort of 200 patients from an LPN database of over 500 patients. Thirty-five (17.5%) patients had complications. The overall complication rate was 19%. Of the complications, 20% were grade I, 42% were grade II, 26% were grade III, and 2.6% were IV. No grade V complications occurred. Compared with the first 200 patients in our LPN cohort, this contemporary cohort had significant decreases in overall, urologic, and hemorrhagic complication rates despite an increase in tumor complexity. Increased experience with advanced laparoscopic techniques has allowed for a significantly reduced complication rate after contemporary laparoscopic partial nephrectomy (LPN), which now appears comparable to that of open partial nephrectomy. We advocate the development of a standardized complication reporting system.

Best Scientific Paper—Multispecialty
Experimental Studies of Peroral Transgastric Abdominal Surgery: Tubectomy, Hysterectomy. Is it the Next Minimal Invasive Approach?

Submitted by Stefanos Chandakas, MD, MBA, PhD, Chris Feretis, MD

Peroral transgastric surgery, a less invasive type of surgery, is technically feasible and safe in a porcine model and needs to be studied further.  We performed incisionless endoscopic peroral transgastric procedures on 10 anesthetized pigs, which included peritoneoscopy, liver biopsy (1), cholecystectomy (6), fallopian tube excision (1), and hysterectomy (1). In 4 animals, peritoneoscopy liver biopsy and cholecystectomy were performed successfully without intraoperative complications. In survival studies, 6 of the 10 pigs that underwent cholecystectomy, tubectomy, and hysterectomy had uncomplicated recover at 4 to 6 weeks.

Best Scientific Paper—General Surgery
Laparoscopic-assisted Colonoscopic Polypectomy: Long-term Results

Submitted by Morris E. Franklin, Jr, MD, Guillermo Portillo, MD, Jefrey L. Glass, MD, John J. Gonzalez, Jr, MD

A combined endoscopic-laparoscopic approach offers a valid alternative for treating difficult colonic polyps and eliminates the morbidity of a segmental resection. Long-term follow-up demonstrates that this technique is safe and effective. A total of 190 polyps were removed as follows: 112 right colon (59%), 23 transverse (12%), 12 left colon (7%), and 33 rectosigmoid (22%). In 96% of patients, laparoscopic-monitored colonic polypectomies were performed successfully. Full-thickness resection was required in 4% of patients because of technique problems and positive margins. In a mean follow-up of 74 months, there have been no recurrences.

Evolution of Fetal Surgery

FROM THE 16TH SLS ANNUAL MEETING AND ENDO EXPO 2007, SAN FRANCISCO, CALIFORNIA, SEPTEMBER 5–8, 2007

PRESENTED BY JOSEPH BRUNER, MD

The types of fetal surgeries being performed are growing. The first in utero surgery was bladder open fetal surgery for lower urinary tract obstruction (LUTO). Liver surgery has been performed, as has congenital high airway obstruction (CHAOS) surgery. PLUG, plug the lung until it grows, is a new method for treating congenital diaphragmatic hernias. A flexible endoscope is inserted in the mouth of the fetus, and a balloon is passed through the throat then expanded to open the lungs. The balloon is popped and the baby expels it. Congenital cystic adenomatoid malformation (of the lung) (CCAM) surgery is also being performed; however, sometimes the fetuses die before they heal. Sacrococcygeal teratoma, congenital germ cell tumor arising from the presacral area, surgery is being performed too, but it has a mortality rate of 30% to 50% because it is difficult to occlude vessels to prevent huge blood loss when the tumor is resected and it is hard to tell where the tumor ends and the fetus begins. Intrauterine therapy has also been performed for nonlethal disorders, such as spina bifida. The da Vinci robot has been used in the sheep model for intrauterine surgery, with all robotic surgeries being performed satisfactorily. Although fetal surgery is promising, it is not without problems. For example, all pregnancies need to be performed by cesarian delivery because of the port holes, the working space is small, it is difficult to work in a gas or liquid environment, fetal positioning, port size, and membrane damage.

Keynote Address: Adaptive Innovation

FROM THE 16TH SLS ANNUAL MEETING AND ENDO EXPO 2007, SAN FRANCISCO, CALIFORNIA, SEPTEMBER 5–8, 2007

PRESENTED BY JOHN KENAGY, MD, MBA

John Kenagy, MD, a vascular surgeon broke his neck. “Despite the system, said Kenagy, “I had good outcomes.” The system got in the way; but, the good outcome was because of people going the extra mile. He is walking, talking, and has no impaired movements. However, he cannot practice surgery, so he went into management. He helps managers find solutions. It is important to understand that future success is based on one’s ability to adapt to a changing environment, said Kenagy. Current organizations will stall or block adaptive change. According to Clayton Christensen, it is almost impossible for established companies to be innovative. When an industry transforms, it starts at the low end, not the high end. But it is difficult for management leaders to make the leap from the high end to the low end. Toyota is so successful because it is “designed to adapt.” How can a company become adaptive? What is adaptive design? It is adaptive innovation and Toyota combined.  First, establish an operational framework that fosters high performance and innovation focused on the patient. Second, eliminate ambiguity, assumptions, work-arounds, and tradeoffs. Third, develop every person’s skills, knowledge, creativity, and problem-solving ability. Fourth, embrace the team. And fifth, make inquiries if things aren’t working smoothly. Key points to remember are the following: senior management must decide where it wants to be; realize that advice of experts is usually useless; discover the adaptive spectrum of opportunity; inventory what you’re doing and rebalance your opportunities; execute your intentions; and the role of management needs to be revitalized. Adaptive units always outperform others. “It is not the strongest who survive,” said Kenagy, “but the most adaptable.”

Future Technology Session: The Edge of Innovation in Surgery, Space, and Business

FROM THE 16TH SLS ANNUAL MEETING AND ENDO EXPO 2007, SAN FRANCISCO, CALIFORNIA, SEPTEMBER 5–8, 2007

SURGERY IN SPACE: NEEMO MISSION

PRESENTED BY TIMOTHY BRODERICK, MD

Astronaut-physicians are being trained for space travel by performing surgery in extreme environments. The more extreme environment increases the risk and severity of injury. Small animal surgeries are already being performed during space flight to validate whether surgery is possible in flight. Computer-based surgical simulation is being used also in micro-gravity surgery, which actually improves visualization, and robotic surgery in micro-gravity can be more stable than robotic surgery in earth’s gravity.

The Aquarius, the only underwater sea lab in the world, was developed to simulate the environment on the moon so that NASA extreme environment mission operations (NEEMO) could be undertaken. On one NEEMO mission, a physician in Canadian, directed surgery being performed on the underwater Aquarius.

NEEMO 7 tested how by using telehealth, a nonsurgeon or nonphysician can do surgery with a telementor far away. A laparoscopic cholecystectomy was performed as well as if a physician had done it; however, vascular surgery was not.  Telementoring facilitates expert care at distances. A problem is secondary latency, which can be overcome via technique and technology. NEEMO 7 demonstrated that surgeons perform surgery better than nonsurgeons do, and therefore, surgeons should be taken on missions into space.

NEEMO 9 looked at telemedicine and telesurgery. Simulated knee ultrasound and arthroscopy were successfully performed despite the lunar latency. Telementor, telementee, and communication protocols can overcome latency. Another NEEMO finding is that in vivo robots could improve care in extreme environments. Robotic telesurgery was demonstrated in the Aquarius with a physician in Canadian operating the robot underwater.

NEEMO XII used 2 robots to perform telesurgical ultrasound under the guidance of a Veress needle with the physician in Tennessee.

SLS REPORT: Expo 2007 in review

16TH SLS ANNUAL MEETING AND ENDO EXPO 2007 IN REVIEW

GUSTAVO STRINGEL, MD

The city of San Francisco was a great venue for the 16th Society of Laparoendoscopic Surgeons (SLS) Annual Meeting and Endo Expo 2007. This beautiful and welcoming city, a place where visitors leave their hearts, is great for meetings. Transportation to San Francisco was convenient with 2 major airports, the San Francisco and the Oakland International airports. The Hotel Hyatt Regency Embarcadero provided a great venue for the meeting. It is strategically located in downtown San Francisco, and the accommodations were comfortable with spacious rooms. The hotel overlooked the San Francisco Bay and the spectacular Bay Bridge. I personally recommend using public transportation from the airport to the hotel; the train is convenient and inexpensive.

The masters classes were well attended and interesting. Suturing continues to be a skill that is sought out by most laparoendoscopic surgeons; the suturing class was very well received.

The Society’s recent innovation of designing your own program schedule allows for flexibility. This new system allows the surgeon to tailor the classes to his or her particular needs. Surgeons attending future SLS meetings are advised to take advantage of this interesting didactic option.

The opening ceremony started with the rhythmic percussion of drums played by a Chinese troupe of street dancers with their traditional costumes, including the prominent role of the dragon.

The honorary chairman Mark Erian, MD, delivered a very interesting presentation titled “The Society of Laparoendoscopic Surgeons and the Future of Endoscopic Surgery Worldwide.” SLS’ honorary chairman Yan Liu, MD, talked about “The Economy and Culture of Shanghai and Its Development in Endoscopic Surgery in Gynecology.”

The presidential address by Dr Harrith M. Hasson, MD, was the highlight of the evening. Dr Hasson is world renowned for his innovations and contributions to the field of laparoscopy.

The Best of Laparoscopy Updates was provided by Dr Howard Winfield from the urology committee and Dr Maurice Chung of the abdominal pain and adhesions committee.

This year, SLS had the honor of having Dr Thomas Russell, the current director of the American College of Surgeons, as their keynote speaker.

SLS continues to strive to provide multidisciplinary service to our members as illustrated by the multidisciplinary plenary sessions. The presentations included improving practice performance, safety, quality, pay for performance, transparency, and the financial aspects of surgical care. A highlight of this session was the presentation by Dr Thomas J. Fogarty, a well-known and respected innovator, whose talk “Bringing your Surgical Idea to Reality” was inspiring. This session was well complemented by the presentation of Mr Mike Henson and Mr John Savarese about the commercial and business aspect of inventions.

The poster session was well represented in San Francisco with excellent posters from around the world.

The concurrent scientific sessions continue to be one of the strengths of SLS. We had very interesting presentations from many countries, and most laparoscopic specialties were represented. We had a plethora of impressive scientific presentations. We continue to experience progressive improvement in the scientific and forum presentations, not only in their clinical validity, but also in the extraordinary audiovisual quality.

The SLS group event of the evening in 2007 was a visit to the Conservatory of Flowers. The evening was very interesting.

The live telesurgery session could not be delivered in the usual format. This challenge presented the opportunity for SLS leadership to innovate, and the result was a new format currently known as “virtual telesurgery.” This format allowed for the audience to watch a previously recorded unedited video as if it were live. The surgeons performing the procedure were actually present at the annual meeting, and they acted as monitors of the session. Many of the attendees actually believed that the session was live. SLS may utilize this innovation in a similar or modified format in the future.

Dr Ralph Clayman introduced our Excel award recipient, Dr Elspeth M. McDougall, who delivered an excellent lecture titled “The Future of Surgery is Education.”

The Annual Meeting and Endo Expo concluded with a sit down breakfast with spouses and guests. The keynote speaker was John Kenagy, MD, MBA, who talked about “Adaptive Innovation.” Dr Richard Satava was the director of the future technology session titled “The Edge of Innovation in Surgery, Space, and Business,” Dr Timothy Broderick talked about the NEEMO Mission, and Dr Joseph Bruner about “Fetal Surgery.”

The closing ceremony ended this wonderful meeting with the passing of the presidential gavel from Dr Harrith Hasson to our new president Dr William E. Kelley, Jr.

It was with sadness that we saw the conclusion of this great educational and social event. We are now preparing ourselves and looking forward to the next Annual Meeting in Chicago. SLS is preparing an excellent educational and social program.

See you in Chicago!