World Congress of Laparoscopic Surgeons on 10th and 11th of October 2020

Please go to the link below to register for Eighth World Congress of Laparoscopic Surgeons - WALS 2020

https://www.laparoscopyhospital.com/walsregistration.html

The International Hernia Collaboration is the world's largest hernia community. Led by New York based surgeon Brian Jacob, the IHC consists of more than 5000 surgeons, including those who have described operations, conducted the best trials and published hernia (and other) textbooks.

The IHC has become the most disruptive influence in hernia surgery today. Peer based teaching, feedback, criticism and mentoring on case-to-case basis with the help of videos, images and even live streaming has revolutionized practices of surgeons from Azerbaijan to Zimbabwe.

The IHC is now the most potent source of education in all things hernia, be it subcutaneous endoscopic abdominal wall closure or robotic parastomal surgery repair.

Endometriosis patients undergoing laparoscopy should wait seven to 25 months before in vitro fertilization (IVF), concludes a retrospective analysis by researchers at the University of Toronto.

Their study, “In Vitro Fertilization (IVF) Success Rates after Surgically Treated Endometriosis and Effect of Time Interval between Surgery and IVF,“ appeared in the Journal of Minimally Invasive Gynecology.

The effects of endometriosis on IVF pregnancy outcomes are still a matter of debate, with studies reporting either a negative effect or none at all. Doctors often perform laparoscopy surgery — a minimally invasive procedure — to treat the disease, but what impact this surgery has on IVF success rates is unclear.

To determine how endometriosis correlated with IVF outcomes, researchers at the university’s Department of Obstetrics and Gynecology — in collaboration with Israel’s Tel Aviv University — performed a retrospective clinical analysis. They looked closely at three main points: the impact of endometriosis staging after surgical treatment, the effects of endometriomas (cysts), and the best time interval between laparoscopy and IVF.

Researchers analyzed data from 216 infertile women with endometriosis and 209 infertile patients without endometriosis, as controls. They defined endometriosis stage according to ASRM criteria, categorizing 58 patients with stage 1, 67 with stage 2, 63 with stage 3 and 28 with stage 4. IVF outcomes were evaluated according to fertilization, implantation and pregnancy rates.

Women with endometriosis showed an impaired ovarian response to the hormonal stimulation used in the IVF procedure, which is why the number of retrieved oocytes was lower when compared to controls.

The analysis also showed that clinical and ongoing pregnancies rates declined in conjunction with endometriosis severity: patients with stage 1 endometriosis had 55 percent of clinical and 50 percent of ongoing pregnancy rates, while women with stage 4 showed 43 percent and 32 percent. Overall pregnancy rates among women with endometriosis were lower when compared to controls.

The presence of endometriomas in patients with stages 3 and 4 endometriosis did not hurt IVF outcomes. The analysis showed that the period between surgical intervention and IVF significantly affected pregnancy rates.

“After controlling for age and stage of endometriosis, we found that the highest ongoing pregnancy rate was achieved in patients who underwent their IVF cycle 6-25 months after their endometriosis surgery,” authors wrote. “IVF delay may be considered to around 6 months from endometriosis surgery but no more than 25 months.”

Overall, these results suggest that endometriosis severity hurts IVF pregnancy rates and that women who are undergoing laparoscopy and are considering IVF should wait at least seven months before the procedure.

Ethicon*, part of the Johnson & Johnson Medical Devices Companies**, announced today the U.S. launch of the ProxiSure™ Suturing Device, an advanced laparoscopic suturing device featuring Ethicon endomechanical, suture and curved needle technologies. Ethicon has been a steadfast champion of minimally-invasive surgery, delivering innovative solutions and support services that promote greater procedural expertise, improved hospital outcomes, and better patient care. The addition of ProxiSure™ builds upon Ethicon's expansive portfolio of suturing technologies while establishing a new standard of excellence in laparoscopic suturing.


ProxiSure™ Suturing Device features wrist-like maneuverability and curved needle in an advanced suturing device that improves suturing precision in tight spaces.1 The suturing precision is deployed by enabling surgeons to reach the desired angle, control bites, and secure knots, as well as to have maximum control of the needle during suturing and knot tying, which may reduce the risk of needle loss.1

"With the patient's health at the forefront of our thinking, we aimed to introduce a suturing device that will help reduce the margin of error in minimally-invasive surgery," said Dr. Niels-Derrek Schmitz, Franchise Medical Director for Ethicon. "Surgeons will now be able to have the same confidence in laparoscopic suturing that they have always had with traditional procedures using Ethicon products."

With a highly intuitive tissue repair experience, ProxiSure™ is designed to enable precise suturing in tight spaces and is well suited for bariatric, general, colorectal, and gynecology procedures. The device's curved needle improves a surgeon's ability to suture a variety of tissue layers, including flat surfaces.1

"Versatility is the key," said Dr. Schmitz. "ProxiSure enables surgeons to do a wide range of tasks in the OR while maintaining an immensely user-friendly configuration."

Ethicon is the market leader in suture technology, consistently bringing cutting-edge products designed to enhance the surgeon's experience, accelerate healing time and improve patient outcomes. As the latest surgical innovation, ProxiSure™ will deliver new value for customers.

For more information about ProxiSure™, visit www.Ethicon.com\PROXISURE

About Ethicon*
From creating the first sutures, to revolutionizing surgery with minimally invasive procedures, Ethicon, part of the Johnson & Johnson Medical Devices Companies, has made significant contributions to surgery for more than 60 years. Our continuing dedication to Shape the Future of Surgery is built on our commitment to help address the world's most pressing health care issues, and improve and save more lives. Through Ethicon's surgical technologies and solutions including sutures, staplers, energy devices, trocars and hemostats and our commitment to treat serious medical conditions like obesity and cancer worldwide, we deliver innovation to make a life-changing impact. Learn more at www.ethicon.com, and follow us on Twitter @Ethicon.

* Ethicon represents the products and services of Ethicon, Inc., Ethicon Endo-Surgery, LLC and certain of their affiliates. Ethicon, Inc. is the legal manufacturer of the ProxiSure™ Suturing Device.

**The Johnson & Johnson Medical Devices Companies comprise the surgery, orthopedics, and cardiovascular businesses within Johnson & Johnson's Medical Devices segment.

MORRISVILLE, N.C. — TransEnterix, a Morrisville medical device company that uses robotics to improve minimally invasive surgery, is making big news by going small.

The company, founded in 2006, by Synecor, a Chapel Hill business accelerator that spun out of Duke University in 2001 to commercialize medical device inventions, says European surgeons have performed the first 3-millimeter micro laparoscopic robotic surgeries in the world using the Senhance Surgical Robot.

The 3mm instruments enable so-called micro laparoscopy procedures, allowing surgeons to make tiny incisions that leave virtually no scars for patients.

Senhance is a multi-port robotic system that allows multiple arms to control instruments and an eye-sensing camera with haptic feedback, or the sense of touch. The system simulates laparoscopic motion familiar to experienced surgeons and features three-dimensional, high-definition vision technology.

Trying out TransEnterix's systemTransEnterix acquired Senhance, previously called ALF-X, in 2015 by purchasing the surgical robotics division of SOFAR S.p.A., an Italian health care company. The cash and stock deal totaled $99.8 million.

European regulators have granted Senhance a CE Mark, a regulatory approval allowing its sale in countries within the European Economic Area for laparoscopic abdominal and pelvic surgery, as well as limited thoracic operations excluding cardiac and vascular surgery. The system is not yet available for use in the United States, but it is under FDA review and the company expects approval in 2017.

Doctors at CHU Saint-Ètienne in France, and at the Policlinico A. Gemelli Foundation in Rome, performed the surgeries with the 3mm devices. Professor Celine Chauleur and Dr. Salvatore Gueli Alletti, gynecologic oncologists, and Dr. Gabriele Barabino, a general surgeon, were the first surgeons in the world to use micro laparoscopic instruments with an abdominal robotic surgery platform. The surgeons successfully performed multiple cases in gynecologic and general surgery such as; ovarian cystectomy, endometrial excision, total laparoscopic hysterectomy, bilateral salpingo-oophorectomy and cholecystectomy utilizing robotic microlap instruments.

“Microlaparoscopy with robotic assistance is now a reality utilizing Senhance,” said Todd Pope, president and CEO of TransEnterix. “The use of microlaparoscopy is a growing trend, but it can be challenging to manually control and stabilize such small instruments. We believe Senhance robotic assistance can enable surgeons to expand their use of virtually scarless surgery in more patients, and creates an additional way robotics can bring value over traditional manual approaches.”

Added Barabino, “Patients are consistently interested in the least invasive approach possible. Utilizing 3mm microlap instruments with the Senhance Surgical Robot creates a virtually scarless approach with the precision of robotics to control such small instruments with delicate haptic force feedback.”

INTRODUCTION
Ectopic pregnancy has become a worldwide “epidemic”. From 1970 to 1992, its incidence has increased by 9 times. The prevalence is estimated at 1.6 ectopic pregnancies per 100 births with a maternal mortality rate up to 9% when of interstitial type. In Mexico, investigators reported a rate of 6.1 per 1000 live births, with immediate and late complications that resulted in infertility or maternal mortality. (1)
CERVICAL ECTOPIC PREGNANCY:
Cervical ectopic pregnancies are extremely rare, representing approximately 0.1% of all ectopic pregnancies. The incidence is estimated at 1:2,500 to 1:98,000 pregnancies. Before the decade of the 1980s, the diagnosis was only made retrospectively, when after performing the dilation and curettage for incomplete abortion there was uncontrollable bleeding resulting in hysterectomy. (2) Recognized risk factors for cervical ectopic pregnancy are, lesions or previous scars on the cervix, uterine curettage, chronic pelvic infections, and use of IUD. Also, pregnancies achieved through in vitro fertilization and embryo transfer. (2)
There are case reports describing full term cervical ectopic pregnancies as the one described by Dr. Rokitansy in 1860. The contemporary accepted diagnostic criteria of cervical ectopic pregnancy are based on the contribution of Dr. Studdiford referring to it as the “kind of abnormal pregnancy with cervical implantation”. There are 28 cases reported in the literature before 1945, half of which were made as retrospective diagnosis based on pathology results. Of these, 6 patients died and some required blood transfusion of up to 11 liters of blood. Dr Studdiford himself treated two cases. (3)
The traditional treatment this pathology is hysterectomy as a result of uncontrollable bleeding or planned in up to 70% of cases. (4. 5) There have been multiple treatment modalities described, from evacuation by instrumented curettage that in most cases results in uncontrollable bleeding requiring subsequent hysterectomy. Also, selective uterine and/or hypogastric artery embolization has been described prior to attempting endocervical tissue removal. (7) A recent approach has been the use on methotrexate (MTX) 1 mg/kg, administered IV, IM or as an intra-amniotic injection under sonographic or hysteroscopic guidance, in some cases with intraamniotic KCL injection, followed by serum HGC weekly level monitoring. (8.9)
If the diagnosis is made before bleeding, there is an option to decrease the trophoblastic invasion by establishing conservative medical treatment with methotrexate or etoposide. (10)
CASE REPORT:
The patient is a 28 years old primigravida, who presented complaining of slight vaginal bleeding and a positive home pregnancy test. She was 3.5 weeks dated by last menstrual period. Transvaginal ultrasound revealed no evidence of gestational sac; in the left ovary there was an anechoic image of 2 x 1 cm, suggestive of corpus luteum. Beta HGC was 1410 mIU/ml. Patient was stable and plan to repeat US in 1 week and serial HCG level was made. At 4.5 weeks the repeat HCG level was 4878 mIU/ml. The ultrasound examination revealed uterine cavity with an empty 10 mm gestational sac without fetal pole, there was an evident yolk sac at the endocervical region (Image 1). Medical management with methotrexate 1 mg/kg/day on days 1,3,5 and 7, with rescue therapy of folic acid on days 2,4,6 and 8 with intended maximum 4 doses was started.
After one week the repeat HGC: 7,344 mIU/ml. At that point an additional 50 mg of methotrexate were administered IM and decision was made to proceed with operative hysteroscopy with a Bettocchi hysteroscope. The cervix was located by vaginoscopic approach which revealed a protruding red mass with a diameter of approximately 3 cm, and the presence of a gestational sac implanted in the endocervix was confirmed. (Image 2) Coagulation and subsequent cut with bipolar spring electrode (screw) using VersaPoint generator (Gynecare) starting from lateral to medial until complete coagulation of implantation site was achieved with consequent excision. (Image 3) To complete the excision of the surgical specimen, a speculum was placed in the vagina and the gestational sac was removed using ring forceps. (Image 4)
Pathology confirmed the presence o endocervical epithelium and chorionic villi. Hysteoslpingogram performed 3 months postoperatively showed endocervical canal, uterus and bilateral patent normal fallopian tubes. (Image 5)
DISCUSSION
Although mortality rates have declined from 45% to almost 0%, conservative management of this condition is not always without complications. There is no consensus on the best medical or surgical treatment of cervical ectopic pregnancy. The management of this pathology is based on anecdotic information. Many questions remain only answered with no solid medical evidence. What is the best gestational age to treat this pathology? What is the proper use of methotrexate and KCL? What are risk factors for poor outcome? Are there contraindications for a conservative approach?
We believe that operative hysteroscopy, in expert hands, is a safe alternative for the treatment of cervical ectopic pregnancy in patients who desire future fertility.
REFERENCE:
1. Cerna Rodríguez. Embarazo Ectópico. Ginecología y Obstetricia Aplicadas, capítulo 4 Páginas: 23; 30 JGH Editores, 2000.
2. Plascencia Moncayo N, and cols, Embarazo Cervical. Tres casos. Ginecol Obstet, Mex 2008; 76: 744-747.
3. Baptisti Artur JR MD, Cervical Pregnancy, Obstet Gynecol 1958 :3: 353-358,
4. Ranade Vinary and cols, Cervical pregnancy Obstet Gynecol. 1978:51(4)502:505
5. Segna RA, MD and cols, Obstet Gynecol 1990 ;76: (5) 945-947
6. Montañana P and cols, Embarazo Ectópico Cervical, Resolución por Histeroscopìa a Propósito de un caso. Rev Iberoam Rep 2004; 21:3:201-205
7. Eun Hwan J and cols. Triplet Cervical Pregnancy treated with Intraamniotic Metotrex. Obtet Gynecol 2002;100: 5
8. Pérez Medina, Rayward J. Embrioscopia transcervical, Histeroscopia diagnóstica y terapéutica. Editorial Médica Panamericana 2008;16:178-187
9. Vizcaíno Magaña CV and cols, Embarazo cervical; Comunicación de un caso y Revisión de la Literatura, Ginecol Obstet, Mex 2006; 74: 594- 598
10. Molina Sosa MD, Tratamiento conservador, Laparoscópico y médico del embarazo ectópico; Ginecol Obstet, Mex 2007;75: 539- 548
11. Rojas Mora E MD and colas, Tratamiento Médico del embarazo ectópico no roto. Ginecol Obstet, Mex 2004;72: 135-141
12. Madrazo Basauri M, Valoración Clínica del embarazo ectópico (hace 55 años) Ginecol Obstet Mex 2007; 75: 304-307,
13. Gutiérrez Najar A MD, Rivas López R.MD, Embarazo ectópico persistente. Implantación tardía útero peritoneal. Ginecol Obstet, Mex 2008;76: 182-186.
14. Mancera Reséndiz MD and cols, Embarazo Heterotòpico espontáneo. Reporte de un caso. Ginecol Obstet Mex.2011;79: 377-381.
15. Ramírez Arreola MD and cols, Embarazo ectópico cornual. Comunicación de un caso y Revisión Retrospectiva de cinco años. Ginecol Obstet, Mex 2007; 75 : 219-223.
16. Barrón Vega R de J, Embarazo ectópico,Obstetricia y Medicina perinatal ; temas selectos tomo 1 Comego 2006; 16: 165- 171
17. Scutiero G. MD and cols, Cervical pregnancy treated by uterine embolization combined with Office hysteroscopy, Eur J Obstet GYN RB 2013;166: 104-106

Philadelphia—For decades, residents have withdrawn from general surgery training programs at far higher rates than other specialties. Now, the first study of its kind shows that women, particularly those from ethnic minorities, are most likely to leave.

In the first longitudinal national cohort study designed to identify surgical residents at risk for dropping out, sex was the most important predictor of withdrawing from a general surgery training program. Overall, 24% of women and 17% of men abandoned general surgery training. Nonwhite women, particularly those in academic programs, had the highest dropout rate (35%).

The study was presented at the 2017 annual meeting of the American Surgical Association.

But there are far more factors at play than simply sex and ethnicity, said lead author Heather L. Yeo, MD, MHS, assistant professor of surgery and healthcare policy and research at Weill Cornell Medical College, in New York City.

“This is really the first study to show that there are individual risk factors that together put a person at risk,” she said.

The reasons are complex, and reflect personal and program factors. In fact, some groups of men had high attrition rates while some women, especially those in small community programs, were less likely to drop out than most men, she noted.

“This is the first opportunity to really characterize individuals based on some more in-depth factors that put them at risk. Every woman is not at equal risk.”

Dr. Yeo and her colleagues carried out a nationwide eight-year prospective cohort study of general surgery interns from the class of 2007. The survey results were then linked to data from the American Board of Surgery, including ABS In-Training Examination dates and scores, residency completion, board status, and program characteristics. Nonparametric classification and regression tree analysis identified risk factors for noncompetition of training at the resident level. This type of analysis allows for deeper exploration of the factors affecting individuals for whom attrition was an issue.

Of 1,047 general surgery interns in 2007, 80% completed training. The residents least likely to drop out were non-Hispanic, married, white men studying at smaller nonacademic programs outside the Northeast (5%). White women at small community programs who had a relative in medicine had a similarly low dropout rate (6%).

For women, the most important factor in completing residency training was race, with 30% of nonwhite women leaving compared with 20% of whites. For nonwhite women, the attrition rate was highest in academic programs (35%) versus nonacademic programs (30%). White women in large academic programs were more than twice as likely to drop out than those in smaller programs (25% vs. 11%).

For men, program size was the most important predictor of leaving general surgery residency. Twenty-three percent of men in larger programs dropped out, compared with 11% in smaller programs.

The study findings should not and cannot be used as a screening tool for potential residents, Dr. Yeo noted. “You can’t assume every woman is more likely to drop out or that you should not train women. That’s not a solution, and it’s not an accurate assessment. Many women do very well in training. They are over 50% of the resident workforce, so we now need to figure out how to support them and train them.”

But programs could retain more residents through mentorship of at-risk residents by increasing the numbers of women and ethnic minorities on faculty in teaching programs, she noted. More support structures for residents, including day care and better options for residents who have family or personal emergencies, also would be beneficial.

Mary Hawn, MD, professor of surgery and chair of surgery at Stanford University, in California, said the study highlights the need for diversity among faculty and residents. “It is incumbent on us to create inclusive training environments. Having diversity improves the cultural competency of the program, which has a positive effect on patient care.”

Mary E. Klingensmith, MD, the Mary Culver Distinguished Professor of Surgery and vice chair for education at Washington University School of Medicine in St. Louis, said surgical patients are more diverse than the surgical workforce, and patients may have preferences for physicians with an origin or sex similar to theirs. “A more diverse workforce serves our patients well, but we also become more receptive to patients of different genders and cultures if we are working in more diverse environments where diversity is embraced, accepted, understood and considered an everyday occurrence rather than a rarity.”

The Institute of Medicine’s 2003 report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” found that racial and ethnic minorities receive lower-quality health care than nonminorities, even when access-related factors, such as patients’ insurance status and income, are controlled. The authors concluded that the health care workforce and its ability to deliver quality care for racial and ethnic minorities can be improved substantially by increasing the proportion of underrepresented U.S. racial and ethnic minorities among health professionals.

Dr. Klingensmith also suggested that programs consider outreach efforts to residents’ families to raise awareness of the difficulty of residency and the need for support. The study surprisingly showed that residents with family who lived nearby were less likely to complete residency. Female residents with family members living nearby had higher rates of attrition than those without; 39% of female nonwhite residents studying in academic programs with family nearby left their programs before completion. Surgical educators who listened to the presentation said family sometimes may support a resident’s decision to leave due to stress.

For the past 25 years, attrition rates have remained steady in general surgery, with about one in four residents not completing training. That is much higher than other specialties, including surgical specialties. Orthopedic surgery has a dropout rate of less than 1%, OB-GYN is about 4.5%, and medicine is about 5%.

“It was thought that changes in work hours and the kinds of things might lower the attrition rate, but they have not. So we need to look at other solutions,” Dr. Yeo said.

Resident characteristics that did not significantly affect the completion of training included marital status, attending a U.S. or Canadian medical school, and geographic location of a residency program. Attrition rates were higher (24.4%) in larger programs, defined as more than six chief residents graduating each year, than smaller programs (17.7%). Military programs had the highest attrition rates (35.5%) versus academic programs (20.4%) and community programs (16.7%).

Intern age was unavailable for this sample, and there were no data on marriage or children among residents after the start of residency.

There are few reports of interventions designed to prevent surgical resident attrition. In 2010, surgeons from the University of Pennsylvania reported a dramatic reduction in resident attrition after changing the resident selection strategy in 2005. They added an essay and structured interview to the process that allows them to select traits that are aligned with the ethos of their program and assess perseverance and success in difficult situations (Ann Surg 2010;252:537-541). However, critics of this approach say it screens trainees who are likely to complete residency, but does not necessarily identify those who would be good physicians.

The full study is expected to be published in an upcoming edition of the Annals of Surgery. It was presented this spring at the 2017 annual meeting of the American Surgical Association, the oldest surgical association in the United States.

Things began to go seriously wrong shortly after the Ontario woman’s routine gallbladder surgery started.

After she was put under general anesthetic, the surgeon made an incision into the woman’s navel, and then inserted a sharp bladed trocar, a thick, pen-like device used during laparoscopic surgery to create a portal or hole into the abdominal cavity through which instruments and cameras can be passed.

The doctor had difficulty getting the trocar in, and so he gave it a little “extra shove,” according to his operative notes, accidentally puncturing the woman’s abdominal aorta in the process.

By the time the injury was detected, the pooling blood had caused such significant nerve damage the woman was left with chronic, debilitating pain. The case went to a court-decided settlement, and the woman was awarded just under $1 million in damages, according to her lawyer, John Makins.

The case is one example of the legal risks doctors are being warned they can face when minimally invasive keyhole surgeries “do not go as planned.”


A review by the Canadian Medical Protective Association (CMPA) of 423 medical-legal cases involving laparoscopic surgery found injuries involving lacerated or damaged bowels, blood vessels, reproductive organs or nerves, delays in recognizing and treating injuries and surgery on the wrong body part, or patient.

In all, 46 people died. The review covered cases closed between 2011 and 2015. Experts were critical of the care provided in 74 per cent of them. Forty percent of patients suffered severe harm or died.

At the Samuel A Cosgrove Memorial Lecture on May 6, 2017, a debate about robotic versus laparoscopic hysterectomy was collegially undertaken by Arnold P Advincula, MD, of the Sloane Hospital for Women at New York Presbyterian/Columbia University Medical School in New York, New York, arguing for the use of the robot in hysterectomy and Matthew Siedhoff, MD, MSCR, at Cedars-Sinai-Medical Center in Los Angeles, California, arguing against using the robot.

At the beginning of the debate, attendees were asked if they used laparoscopic or robotic surgery, with about 50% doing the hysterectomy procedure laparoscopically. They were then asked why they didn’t use the robot. Very few said that size of uterine pathology was the reason for avoiding the robot, while cost and experience were the mostly likely reasons for avoiding the devices.

Dr Advincula, who said that he’s been using robotics since 2001, stated that the robot should be seen as one step in the evolution of the laparoscopic procedure. When approaching the use of the robot, surgeons should do what they do best and cautioned that no piece of surgical technology can replace the knowledge that a surgeon brings to a procedure. He also said that the cost of the robot is not what one would think, as the device is not used just in the ob/gyn unit of the hospital, but other units will use it as well. Dr Advincula said that with the negative publicity that has surrounded the robot, attention has come to focus on cost, the learning curve associated with the device, and experience. He closed by pointing to a 1992 editorial in Obstetrics & Gynecology in which the author wondered if laparoscopic surgery was more than a gimmick and to a follow-up in 2010 in which the author said that laparoscopic surgery had become useful.

When starting his side of the debate, Dr Siedhoff said simply that robotics is not needed in gynecologic surgery. He argued that the aggressive push by device companies had made hospitals and surgeons feel like they had to offer robotics or be left behind, but that it brings with it technical demands and opens up more opportunities for risk. He said that one of the biggest problems with research into efficacy is that there’s incredible difficulty working around bias because randomized controlled trials are not possible and that the literature can be interpreted to fit the bias of the reader. In addition, he pointed out that the difficulties inherent in evaluating robotic surgery because of the many variables, such as a surgeon’s record and the possibility that skill with the technology would improve over an individual’s career. Dr Seidhoff closed by saying that the robot is not necessary but asked if the robot can be used ethically. Given sufficient volume, judicious instruction of trainees, and investment in a teaching team, the technology might provide results equivalent with laparoscopy.

During the course of his rebuttal, Dr Advincula said that the two sides of the debate were fairly close to each other. High volume and the surgeon’s skill set, he said, were important for either robotic or laparoscopic surgery. Dr Advincula said when comparing the cost in his department between the two types of surgery, they were roughly equivalent and that the cost of the surgeon’s time often is not factored in. Dr Siedhoff said that he felt that conventional laparoscopy was easier to replicate for trainees and teaching them anatomy was easier than instruction on the robotic platform.

Following the debate, attendees were asked if the debate had altered how they might operate in the future and there was some movement with more people saying that they might start to use the robot more often. Forty-two percent said that lack of experience with the robot was the reason they would avoid the technology. Roughly 30% of attendees said that the debate would affect how they approached minimally invasive surgery in the future.

In the treatment of small renal masses, robotic partial nephrectomy (RPN) has a superior morbidity profile compared with laparoscopic partial nephrectomy (LPN), according to an updated meta-analysis of related studies.

The results are the "strongest available evidence" regarding perioperative outcomes because no completed or ongoing randomized trials have compared the two approaches, say the authors, led by Jeffrey J. Leow, MD, a urology resident at the Tan Tock Seng Hospital in Singapore and researcher at Harvard Medical School in Boston, Massachusetts.

The new study is published in the November edition of the Journal of Urology.

Partial nephrectomy, in forms such as RPN and LPN, is the gold standard treatment option for clinical T1 renal masses, according to the authors.

However, surgical practice has already moved in the direction of the robotic approach for these masses, say Josh Halpern, MD, and Jim Hu, MD, MPH, urologists from the Weill Cornell Medical College in New York City, in an accompanying editorial.

"National practice patterns reveal that laparoscopic renal surgery has given way to the robotic approach likely, in part, due to the shorter learning curve for RPN and the inadequacy of laparoscopic training during residency," they observe.

Still, "surgeon experience remains paramount, regardless of operative approach," they add, while also declaring that "the diffusion of RPN and its superior outcomes may render LPN increasingly rare in the near future."

The study authors echo these comments and explain that the changes in kidney surgery follow those seen in prostate cancer. "The rapid adoption of robot-assisted radical prostatectomy has increased urologists' experience and familiarity with pelvic robotic surgery," they write.

Nevertheless, with regard to outcomes, the superiority of RPN vs LPN "is still a controversial issue," they also say, noting that other meta-analyses have had "mixed results."

Importantly, the recent publication of eight new studies (as late as 2015) necessitated "an updated and accurate meta-analysis," the authors summarize.

In their new meta-analysis, the investigators report multiple advantages with RPN, including shorter warm ischemia time, decreased likelihood of conversion to open surgery, and fewer positive margins and complications.

The team reported these outcomes after performing a literature search through December 2015 that totaled 4919 patients and 25 studies (which all compared RPN and LPN) and then executing a meta-analysis to evaluate safety, effectiveness, and functional outcomes.

The two groups did not significantly differ in terms of age, sex, laterality, and final malignant pathology.

However, patients treated with RPN had larger tumors (weighted mean difference [WMD], 0.17 cm; P = .001), higher mean nephrometry scores (WMD, 0.59; P = .002), and a decreased likelihood of conversion to laparoscopic/open surgery compared with patients undergoing LPN (relative risk [RR], 0.36; P < .001).

Patients treated with RPN also had, compared with those treated with LPN, a decreased likelihood of any complications (Clavien 1 or greater) (RR, 0.84; P = .007) and major complications (Clavien 3 or greater) (RR, 0.71; P = .023), positive margins (RR, 0.53; P < .001), and shorter warm ischemia time by 4.3 minutes (P < .001).

Both approaches had similar operative times (WMD, –12.2 minutes; P = .34), estimated blood loss (WMD, –24.6 mL; P = .15), and postoperative change in estimated glomerular filtration rate.

The new study does not report long-term oncologic outcomes, including overall survival, because of the short follow-up time.

Of the results, the authors highlighted the fact that the nephrometry score, which is a measure of tumor complexity, was higher overall in the RPN group, which nonetheless had superior outcomes overall. This is the first meta-analysis to consider tumor complexity and compare nephrometry scores in both groups, the authors say.

Previous meta-analyses comparing the perioperative outcomes of RPN and LPN had shown no differences in length of hospital stay, estimated blood loss, operative times, and complication rates, but these studies had small numbers, assert the meta-analysis authors.

The new meta-analysis more than doubled the previous study (Eur Urol. 2015;67:891-901) in terms of patient numbers.

The authors also discuss why RPN may be superior to LPN mechanistically.

The "main advantage" of robot-assisted surgery is "instrument dexterity, allowing the surgeon to perform the complex tasks of excising renal tumors and reconstructing the collecting system and the cortex, while working within the constraints of warm ischemia," they write.

In addition, the authors say that "while laparoscopic surgery inherently shares the same advantages of shorter hospital stay, reduced pain, quicker return to daily activities and better cosmesis compared to open surgery, the limited range of motion from laparoscopic instruments makes PN [partial nephrectomy] challenging."

CANBERRA, Jan. 20 (Xinhua) -- Controversial laparoscopic adjustable gastric banding - or lap band surgery - has been found to be beneficial for "severely obese" teenagers and should be used as a "first option" to manage weight during adolescence, a new Australian study has found.

Researchers from the University on Adelaide on Friday shared the findings of their study, in which they said it was not only an efficient way to manage weight for extremely obese teens, but it also had positive effects on the patients' mental health.

Pediatric surgeon and lecturer at the University of Adelaide, Sanjeev Khurana said the reversible surgery could safely be used by adolescents battling extreme obesity.

"Although gastric banding has been controversial and is currently less used in adults with severe obesity, lap band surgery is one of the most studied surgeries for obesity management, has a high safety record and can be a temporary option to manage severe obesity during adolescence," Khurana said in a statement.

"Our findings support lap band surgery as a safe and effective option for management of adolescents with severe obesity - provided it is performed by an experienced surgeon and managed afterwards."

Meanwhile Pediatric Endocrinologist Alexia Pena said while the surgery can benefit those struggling with obesity, it should be avoided by those who are just a little overweight.

"We are talking about a group of adolescents with severe obesity and significant health and psychological problems related to their increased weight - this is not for everyone," Pena said.

The study found that patient weight and Body Mass Index (BMI) "improved significantly" following the surgery, with the long term BMI loss found to be between 7.1 and 14.7 kg/m2.

"The median BMI reduction of 10 kg/m2 with the lap band is a good result when compared to BMI reduction using the few medications available or lifestyle measures, which is around 1-3 kg/m2," Pena said.

"Lap band surgery is reversible and allows time for adolescents to mature to make a more informed decision on a permanent surgical procedure if required later on in life."

According to the Pittsburgh Post-Gazette (1/11/17), Davis was healthy when she had a hysterectomy with the use of a power morcellator in 2012. Only six days later, she learned that what she thought was a benign fibroid was in fact cancerous, and she was diagnosed with leiomyosarcoma. Despite undergoing chemotherapy and radiation, Davis died in her home on January 6.

Her work to raise awareness of the risks associated with power morcellation has had an effect. The Pittsburgh Post-Gazette reports that at least four insurance companies have stopped paying doctors in various states for gynecologic procedures that require the use of a power morcellator.

Lawsuits have been filed against Johnson & Johnson's Ethicon division and other makers of the power morcellator, alleging the companies knew or should have known about the risks associated with power morcellation but continued to market the devices. As a result, women allege, they were put at increased risk of serious, aggressive cancer without being aware they were being put at such risk. According to reports, some lawsuits have resulted in settlements.

In 2014, Johnson & Johnson sent a letter to healthcare providers, alerting them to a voluntary market withdrawal of Ethicon morcellators. Other companies, however, have not pulled their devices from the market.

Lawsuits were consolidated for pretrial proceedings in MDL 2652, however in 2016, after the majority of the cases in the MDL were resolved, leaving only three against Ethicon remaining, the two sides filed a motion to remand the lawsuits and dissolve the MDL. As a result, remaining lawsuits concerning Ethicon power morcellators are being dealt with separately.

We hope that in this year to come, you make mistakes. Because if you are making mistakes, then you are making new things, trying new things, learning, living, pushing yourself, changing yourself, changing your world. You're doing things you've never done before, and more importantly, you're doing something.

An innovative trocar with an integrated closure system aids suturing of abdominal wall incisions during laparoscopic surgical procedures.

The TroClose1200 provides surgeons with a double functionality; the device acts both as a trocar, through which surgical instruments enter the abdomen at the start of the procedure, and as a device to close internal incisions made during surgery. But instead of inserting the sutures in a time-consuming process at the end of the procedure, the device uses a uniquely designed release mechanism, with the sutures inserted into the tissue at the beginning of the procedure, remaining place throughout the operation, and closed almost automatically upon removal of the device.

This all-in-one device thus provides a secure fascia closure that simplifies and improves laparoscopic procedures. It requires only minimal training, and saves both physician and operating room (OR) time, and also facilitates closing ports that are not currently sutured due to their technical complexity. The device is compatible with all types of trocars: bladed/bladeless, disposable/multiuse, and others. The TroClose1200 is a product of Gordian Surgical (Misgav, Israel), and has been approved by the U.S. Food and Drug Administration (FDA).

“Gordian's TroClose is a very effective system, easy to use and especially useful for younger surgeons, as the learning curve is very short,” said Professor Michel Vix, MD, head of the bariatric and metabolic surgery unit at University Hospital of Strasbourg (France). “TroClose has significant advantages over other gold standard closure devices on the market. Indeed, there is definitely a place for this product in the market.”

While laparoscopic procedures present a less invasive alternative to open surgeries, they often require as many as five ports, ranging in size from 5 to 15 millimeters; larger ports require closing the fascia, as incomplete or insufficient closure can lead to hernias at the trocar site. Current closure procedures involve manually closing the fascia or using a dedicated closure device.

According to the World Health Organization (WHO), nearly 20 to 40% of the adult population and 10 to 20% of children in India are affected by obesity and as far Bariatric surgeries are concerned, only around 13000 are performed every year.

This is just Medical records reveal that around 20% drop outs in Bariatric surgery cases happen because of financial problems. This simply means the EMI option for Bariatric surgery at interest-free rate will be a big help for those patients who are suffering from obesity and having issues regarding affordability.

Though there are many surgeries under Bariatric surgery, most commonly performed Bariatric surgeries are (also called Weight Loss Surgery): Laparoscopic Sleeve Gastrectomy, Laparoscopic Bypass and Mini Gastric bypass. While the three procedures are a little different and are suggested based on the patient's extent of obesity and lifestyle habits, the stomach size is reduced in all the cases, which in turn reduces the food intake and helps in weight loss.

These laparoscopic scar less bariatric surgeries are extremely helpful in reducing and improving co-morbid conditions like diabetes and other weight related issues, however use of advanced technology and technique sometimes make the procedure expensive for the patient.

Through this loan option, the patient can take a loan up to INR 4.5 lakhs and pay in 12 installments at 0% interest rate. Experts believe that this facility will help bridge the huge gap between the requirement of Bariatric surgery and actual number of people getting the benefit of bariatric or weight-loss surgery.

While the zero percent interest Bariatric Patient Loan presents a lucrative option to the patients, experts believe that it is important that the doctors, who eventually recommend the Bariatric surgery, are also informed about the policy so that they could suggest the same to the patients.
Says Mrs. Savitri Kulkarni - a Bariatric Surgery operated patient, "A few months back, I weighed 109 kgs; I wasn't able to lose weight despite multiple attempts and had been considering to get bariatric surgery done for almost two years.

However I couldn't arrange the money for the surgery. I was introduced to a finance company through Dr. Manish Motwani who was willing to give us an interest-free loan EMI option. This was a life changer for me, I was able to get operated and get the option of paying only 1/3rd amount at the time of surgery and the remaining in interest-free EMIs."


There are many patients who have benefited from this EMI payment option. This becomes even more critical considering the #cashcrisis. While we may not have control over the scenario in banks and outside ATMs, we can definitely take a decision today to stay healthy and fit always.
Health truly is wealth today.

PHILADELPHIA (CBS) — Does your surgeon play videos games? Well you may want to hope so, says a study recently published in Archives of Surgery.

According to the study, there was a strong correlation found between video game skills and the ability to perform laparoscopic surgical maneuvers.

Laparoscopy requires surgeons to navigate equipment through a small incision while they watch their maneuvers on a monitor.

The result of the study revealed that of the 33 doctors participating in the study 9 of them played videos games for at least three hours per week.

The results revealed that those 9 doctors made fewer errors, performed faster, and scored better in surgical skills tests than surgeons who’d never played video games before.

“It was surprising that past commercial video game play was such a strong predictor of advanced surgical skills,” Iowa State University psychology professor and one of the study’s authors Douglas Gentile told Reuters.

Numerous studies including one performed by The University of Toronto show that video games, particularly action games like Call of Duty, do in fact improve and sharpen sensorimotor skills that are very important for surgeons using laparoscopic and other robotic surgical techniques.

Doctors stress that this study does not give parents the green-light to let their children play video games to their heart’s content.

Gentile told Reuters, “spending that much time playing video games is not going to help their child’s chances of getting into medical school.”

Obesity has a greater influence on 30-day complication rates following minimally invasive prostatectomy (MIP) versus open surgery for prostate cancer (PCa), according to a new report.

In a study based on 17,693 minimally invasive prostatectomy (MIP) and 4674 open radical prostatectomy procedures nationwide, class I (body mass index [BMI] 30 to 34.9 kg/m2), II (BMI 35- 39.9 kg/m2), and III (BMI above 40 kg/m2) obesity accounted for 25%, 7%, and 2.3% of the population, respectively.

Perioperative complication rates overall were higher after open than minimally invasive surgery (19 vs 5.3%), across BMI classes, Scott Johnson, MD, and colleagues from the University of Chicago, reported in Urology. The open approach was associated with 4.5 time higher odds of any complication compared with any obesity class. The findings add to evidence supporting minimally invasive procedures in general.

For men who had laparoscopic or robot-assisted surgery, increasing BMI influenced rates of a range of complications, including wound, renal, thromboembolic, infectious, neurologic, Clavien grade III to V, and others. Obesity was associated only with wound and renal complications after open RP.

“This stresses the fact that operative challenges for obese patients are not completely overcome by minimally invasive approaches, highlighted by multiple reports of inferior outcomes following MIP in obese patients,” Dr Johnson and his team explained. They acknowledged that disease characteristics were lacking in the database, so they could not assess how PCa grade and stage related to surgical outcomes.

Obesity independently predicted only wound, renal, and thromboembolic complications, in multivariable analyses. Wound complications increased with greater BMI, in agreement with results from prior studies.

Wound complications related more strongly to the open approach than BMI. “Open surgery may lead to more frequent wound problems as a result of local tissue trauma from larger incisions and mechanical retraction of the surgical site, as has been shown in a number of surgical procedures, including radical prostatectomy,” Dr Johnson and colleagues explained.

Using an interaction model, the investigators further determined that obesity status was not a strong influencer of complications by surgical approach in most cases. Overweight status had no bearing.

For patients with endometrial cancer, robotic-assisted laparoscopic surgery is faster than traditional surgery, according to a study published in the November issue of the American Journal of Obstetrics & Gynecology.

Minna M. Mäenpää, M.D., from Tampere University Hospital in Finland, and colleagues compared traditional and robotic-assisted laparoscopic surgery for endometrial cancer in a randomized controlled trial. One hundred one endometrial cancer patients were randomly allocated to hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy by robotic-assisted laparoscopic surgery or traditional laparoscopy; 99 patients were eligible for analysis.

The researchers found that the median operation time was 170 minutes in the traditional laparoscopy group and 139 minutes in the robotic surgery group (P < 0.001). The robotic surgery group also had a shorter total time spent in the operating room than the traditional group (197 versus 228 minutes; P < 0.001). There were five conversions to laparotomy in the traditional laparoscopy group versus none in the robotic surgery group (P = 0.027).

The number of lymph nodes removed, bleeding, and length of postoperative hospital stay did not differ between the groups. There were no significant differences between the groups in intraoperative complications (P = 0.56) and major postoperative complications (P = 0.111).

"Robotic surgery offers an effective and safe alternative in the surgical treatment of endometrial cancer," the authors write.

Researchers at School of Medicine and three hospitals in Chile have demonstrated the safety of a new magnet-driven device that enables surgeons to make fewer incisions while performing laparoscopic gallbladder surgery.

Each year, more than 1 million people in the United States have their gallbladders removed, putting that procedure, called a cholecystectomy, on the nation’s top-10 list of surgeries. The gallbladder is closely sheltered in the curve of the liver, so removing it can be tricky. Even in the most skilled hands, manipulating the laparoscopic instruments used in the surgery poses a risk of causing internal damage that can lead to scarring.

The new magnet-driven device makes the surgery less invasive by obviating the need for an incision through which an instrument is inserted to retract the gallbladder. Instead, an external magnet does that job.

In a paper published online Oct. 24 in Annals of Surgery, the researchers shared the results of a 50-patient clinical trial in which they demonstrated the safety of the device. Homero Rivas, MD, assistant professor of surgery at Stanford and director of innovative surgery at Stanford Health Care, is lead author of the paper. The senior author is Mario Uribe, MD, of the Hospital Salvador in Santiago, Chile.

Nationwide, the device, which has received clearance from the Food and Drug Administration, is in use at Stanford Medicine and two other medical centers.

“Laparoscopy has truly revolutionized surgery over the past 30 years or so, and with very good results, but it still relies on a given number of incisions and instruments,” Rivas said. “Surgeons and patients continuously search for painless, scarless operations. This device takes a step toward that goal by reducing the need for fixed, transabdominal instruments.”

The device has two parts: an external magnet and a slender rod with a detachable clip that includes a magnet. The rod, with the clip at its far end, looks much like the reaching devices that people can use to grab objects from high shelves. A surgeon inserts the rod through the belly button and manipulates its clip to grasp the gallbladder. The clip is then released from the rod but remains connected to the gallbladder.

The external magnet is placed on the abdomen to control the movement of the clip attached to the gallbladder. A rod with a camera attached to it sends video to a monitor in the operating room, giving the surgeon an inside view of the area near the gallbladder. Other instruments are inserted through incisions to detach the organ, after which the rod that was earlier unhitched from the clip is reconnected to it and used to remove the organ from the patient.

The study documented an average hospital stay for patients of 22 hours, and an average pain score of 0.6 on a scale of 0 to 10 seven days after surgery. The average time for patients to return to work was five days.
The device was the idea of Alberto Rodriguez-Navarro, MD, who specialized in minimally invasive surgery in his native Chile and is now CEO of Levita Magnetics, the San Mateo-based company he founded to develop the magnetic surgical system.

Rivas said he has used the device primarily for cholecystectomies, but he believes it is versatile enough to be applied to bowel resections, appendectomies, hysterectomies, gastrectomies and other abdominal surgeries. “I hope that greater availability of the device will allow other innovators to propose other uses that even its pioneers have not thought of,” Rivas said.

Surgeons at three Santiago hospitals — the Hospital Salvador, the Hospital Luis Tisne and the Hospital Padre Hurtado — also are co-authors of the study.

The research was supported by a grant from the Chilean Economic Development Agency and sponsored by Levita Magnetics.

At the AAGL 45th global congress Olympus America Inc announced that the company has received 510(k) clearance from the US Food and Drug Administration (FDA) for the company’s next-generation laparoscopic PK Morcellator, a system for laparoscopic tissue containment and extraction.

Dr Jubilee Brown, Professor, Levine Cancer Institute, Carolinas Health Care System, Charlotte, North Carolina, and Dr Arnold Advincula, Vice-Chair & Chief of Gynecology at Sloane Women’s Hospital, Columbia University Medical Center/New York-Presbyterian Hospital, gave remarks to members of the press at the company’s unveiling of the new system.

The laparoscopic PK Morcellator, which uses energy rather than blades to break up tissue, together with the PneumoLiner, a containment device cleared by the FDA for gynecologic surgery in April 2016, make up the Olympus Contained Tissue Extraction System. Dr Brown’s article “A containment system for morcellation” in the October 2016 issue of Contemporary OB/GYN discusses the PneumoLiner in detail.

The PneumoLiner containment device and PK Morcellator are not indicated for use in women with tissue that is known or suspected to contain malignancy, and should not be used for removal of uterine tissue containing suspected fibroids in patients who are peri- or post-menopausal, or candidates for en bloc tissue removal vaginally or via mini-laparotomy. A strict surgeon training protocol for the system has been validated involving surgeons with varying levels of experience, according to Olympus. Testing conducted with the surgeon training protocol revealed there was no damage to any of the specimen containment bags utilized during this process. Consistent with the FDA’s mandate, surgeons who wish to use the containment system will be required to complete a formal training protocol.

“Contained tissue extraction is continually evolving,” noted Dr Advincula. “As surgeons, it is our duty to evaluate potential solutions to the surgical challenges we face in clinical practice. We are pleased that Olympus has taken the initiative to develop a unique and well tested system designed specifically to facilitate the option for a laparoscopic approach in women who are at a low risk of having an unexpected malignancy at the time of surgery.”

Women have about a 20% less chance of developing heart disease after weight-loss surgery than men, according to new research presented at Obesity Week 2016,

The annual conference is hosted by the American Society for Metabolic and Bariatric Surgery (ASMBS) and The Obesity Society (TOS).

According to researchers from Stanford University School of Medicine, while both genders significantly reduce their risk of developing cardiovascular disease over a 10-year period, women seem to benefit more.

One year after surgery, women reduced their risk by 41%, while men reduced their risk of heart disease by 35.6%.

The study followed 1,989 patients who underwent laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy at the Stanford BMI Clinic.

Biochemical cardiac risk factors (BCRFs) were collected preoperatively and 12 months after surgery.

The Framingham Coronary Heart Disease Risk Score was used to estimate the risk of a heart attack in 10 years before surgery and at the one-year mark.

At one year, women had greater improvement than men for the Framingham Coronary Heart Disease Risk Score — 44.7% vs. 41.4%.

In addition, women who had bariatric surgery had an absolute lower relative risk than men at one year with a one-year risk score of 5.11 vs 11.2 respectively.

Furthermore, women had less abnormal HDL or good cholesterol levels than men at one year — 10.1 vs 21.8, respectively.

Finally, excess weight loss was greater for women — Men: 65.9% ± 21.1%, Women: 73.3% ± 23.8%.

“Obesity is a major and modifiable risk factor for heart disease, the leading cause of death in the United States for both men and women,” said a researcher.

“This study suggests, however, that men and women may respond differently to bariatric surgery when it comes to heart health despite comparable weight loss.”

Notable reductions in the 10-year risk of developing cardiovascular disease for both genders post-surgery were noted with women demonstrating significantly lower risk compared to men pre- and post-surgery.

Men were able to normalize levels of HbA1c and triglycerides and waist circumferences better than women post-surgery. Men may be more metabolically receptive to bariatric surgery.

Women were able to normalize levels of CRP better, maintain higher HDL levels, and had a higher% of excess weight loss following surgery compared to men.

Each gender showed significant cardiac risk improvement in response to bariatric surgery, however that may be through gender-distinct mechanisms.

Metabolic/bariatric surgery has been shown to be the most effective and long lasting treatment for morbid obesity and many related conditions and results in significant weight loss.

The Agency for Healthcare Research and Quality (AHRQ) reported significant improvements in the safety of metabolic/bariatric surgery due in large part to improved laparoscopic techniques.

The risk of death is about 0.1% and the overall likelihood of major complications is about 4%.

According to the Centers for Disease Control and Prevention (CDC), in 2011–2014, the prevalence of obesity was just over 36% in adults, with a higher prevalence among women than men (38.3% vs. 34.3%) and older than younger adults (37% vs. 32.3%).

Obese is medically defined as having a body mass index (BMI), a measure of height to weight, that’s more than 30. The ASMBS estimates about 24 million Americans have severe obesity, which would mean a BMI of 35 or more with an obesity-related condition like diabetes or a BMI of 40.

A 30-year-old Japanese woman who farted during gynaecological operation was badly burned when the gas ignited a laser used in the surgery, reports the Japanese...

Ninety-nine percent of the colorless, but certainly not odorless, gas released when one “passes gas” is a combination of carbon dioxide, hydrogen, nitrogen, oxygen and methane.

The last 1 percent is made by bacteria from your intestines, which is what causes the odor.

Most of the components of flatulence are innocuous, but the hydrogen and methane in the gas also render the gas flammable.

For the most part, that flammability isn’t cause for concern. If anything, it’s a source of humor among young boys at sleep-away camp.

But for one woman in Japan, that flammability proved to have a tragic and lasting impact.

The woman, in her 30s, who has not been named, was undergoing a surgery on her cervix at the Tokyo Medical University Hospital in Shinjuku Ward on April 15. In the midst of the operation, while doctors focused a laser on her cervix, the lower part of the uterus, the woman passed gas.

It’s difficult to overstate how minuscule the chance of that normal bodily function causing a problem truly is.

The laser reportedly ignited the gas, causing a blaze that caught the surgical drape on fire before spreading down her skin. It ended up burning much of her body, particularly from her waist and down her legs, according to the English-language version of the Asahi Shimbun. Her current condition is unknown.

An external committee looked into the incident, and the hospital released a report with their findings Oct. 28.

That report stated that the equipment used in the operation did not, at any point, malfunction.

“When the patient’s intestinal gas leaked into the space of the operation [room], it ignited with the irradiation of the laser, and the burning spread, eventually reaching the surgical drape and causing the fire,” the report said.

Aside from the conditions of the actual surgery aligning to create such a terrible accident, it’s surprising that the patient’s gas could even ignite in the first place. As written in Robert Provine’s book “Curious Behavior: Yawning, Laughing, Hiccupping, and Beyond,” only about a third of people produce “combustible levels of methane” in their gas.

Inverse noted that one reason her flatulence might have led to a fire could be that the patient’s intestines contained an awful lot of methane, which can build up if one eats a lot of foods containing high levels of methane, such as broccoli, cabbage or kale.

The unnamed patient isn’t the only one to experience such horrible consequences.

As Provine wrote in his book:

On a more serious note, a gassy gut can be fatal, as it was for a patient having a colonic polyp cauterized. An electric spark caused the patient’s bowels to detonate, blasting out the colonoscopy and ripping a six-inch hole in the patient’s large intestine.