President
Ian A. Hodgdon, MD
LSU Health New Orleans
School of Medicinea

Vice-President
Juan Salgado-Morales, MD
Universida Central Del Cari

Secretary-Treasurer
Ceana Nezhat, MD
Nezhat Medical Center

Immediate Past President
Sharona Ross, MD
Florida Hospital Tampa

Chairman / Executive Director / Scientific Chair
Raymond J. Lanzafame, MD, MBA
The Society of Laparoscopic & Robotic Surgeons

Trustees 2025-2026
George Melich, MD
University of British Columbia

Robert B. Lim, MD
Wake Forest University

Trustees 2026-2027
Jessica Opoku-Anane, MD, MS
Columbia University

Megan Kennedy Burns, MD, MA
Center for Advanced Laparoscopic Surgery and Pelvic Pain
Dept of Obstetrics & Gynecology
University of Rochester Medical Center

National Advisory Board Trustee (2026)
Iswanto Sucandy, MD
Advent Health

International Advisory Board Trustee (2026)
Silvio Alen Canton, MBBS
University of Padova

Scientific & Technology Advisor/Ex-Officio:
Richard M. Satava, MD
University of Washington

International Advisory Committee Chair/Ex-Officio:
Maurice K. Chung, RPh, MD
Center for Endometriosis, Pelvic Pain & Urogynecology
WVU Medicine, Wheeling & Reynolds Memorial Hospital

Ex-Officio:
Michael S. Kavic, MD
Northeast Ohio Medical University

Jessica Ybanez-Morano, MD, MPH
Cleveland Clinic Mercy Hospital

Ronald Fieldstone, Esq

The Society of Laparoscopic & Robotic Surgeons (SLS)
is proud to announce our 2023-2024 Board of Trustees:

President
Radha Syed, MD
Richmond OB-GYN Associates

Vice-President
Sharona Ross, MD
Florida Hospital Tampa

Secretary-Treasurer
Ian A. Hodgdon, MD
LSU Health New Orleans
School of Medicine

Immediate Past President
Paul G. Toomey, MD
Florida Surgical Specialists

Chairman / Executive Director / Scientific Chair
Raymond J. Lanzafame, MD, MBA
The Society of Laparoscopic & Robotic Surgeons

Trustees (2023-2024)
Juan L. Salgado-Morales, MD
Universida Central Del Caribe
School of Medicine

Robert B. Lim, MD
Wake Forest University
Atrium Health Carolinas Medical Center

Trustees (2024-2025)
Ceana Nezhat, MD
Nezhat Medical Center

Jessica Opoku-Anane, MD
Columbia University

National Advisory Board Trustee (2024)
George Melich, MD
University of British Columbia

Scientific & Technology Advisor/Ex-Officio:
Richard M. Satava, MD
University of Washington

International Advisory Committee Chair/Ex-Officio:
Maurice K. Chung, RPh, MD
Center for Endometriosis, Pelvic Pain & Urogynecology
WVU Medicine, Wheeling & Reynolds Memorial Hospital

Ex-Officio:
Michael S. Kavic, MD
Northeast Ohio Medical University

Ronald Fieldstone, Esq

Editor’s note: Responses have been paraphrased for brevity.

• Raymond Lanzafame, MD, MBA, FACS, Executive Director, Chairman, Scientific Chair of SLS
• William E. Kelley, MD, Former Director of General Surgery, at Henrico Doctor’s Hospital, Past president of SLS
• Mona Orady, MD, Director of Robotic Surgery Services at Saint Francis Memorial Hospital, VP of SLS
• Richard M. Satava, MD, FACS, Professor Emeritus of Surgery at the Univ. of Washington, Advisor to SLS
• Paul G. Toomey, MD, President and CEO Florida Surgical Specialists, Secretary-Treasurer of SLS

Four insights from the discussion:

1. Robotic-assisted surgery has changed the landscape and scope of minimally invasive surgery.
   The introduction of robotic-assisted surgery 20 years ago has shifted a majority of procedures from an open to a laparoscopic procedure or robotic-assisted surgery. The advent of robotic-assisted surgery has changed the landscape of minimally invasive surgery by allowing surgeons to push the limits of minimally invasive surgery to do more and more complex procedures – There’s almost no limit to the possibilities of robotic-assisted surgery. [Mona Orady, MD; Raymond Lanzafame, MD]
2. Robotic-assisted surgery has surpassed all of the barriers that challenge new technologies and will revolutionize surgery.
   Robotic-assisted surgery is now accepted as one of the standard methodologies that surgeons use in patient care. It is stable and accepted at nearly 6000 systems globally with millions of procedures having been performed. As we move into the digital age, the robot has become a global instrument; it is not limited to one’s own operating room or hospital. Everything is connected, and no other part of surgery has that capability except perhaps some components of image guided surgery. [Richard M. Satava, MD, FACS; Mona Orady, MD]
3. The current challenge for residency programs is to supply the breadth of training necessary for the current surgical landscape.
   We’re seeing different levels of robotic-assisted surgery capabilities when residents come out of training, where some can only dock the patient cart, some can operate, and some are completely safe with performing the entire robotic-assisted operation. The current challenge for residency programs is to supply the breadth of training necessary for the current surgical landscape, not just open and laparoscopic as well as endoluminal surgery, but also robotic. We have to create a balance in training so that the next generation of surgeons can do all of these procedure types with equal and exceptional insight, experience, and judgement. [Paul G. Toomey, MD; William E. Kelley, MD; Raymond Lanzafame, MD, MBA, FACS]
4. Simulation is experience
   Simulation training is utilized in many different disciplines, such as the by military or for pilots and astronauts. Simulation provides the indispensable experience and feedback. The beauty of simulation, of course, is you have permission to fail, and nobody is harmed in the simulation. Simulation not only allows you to maintain skills and learn from experience, but it allows you to measure your performance and determine the quality of your performance before you actually go out and operate on a patient. It’s time for healthcare to get on board and integrate the next generation of skill and procedure-based simulation. [Richard M. Satava, MD, FACS]

The content presented on this page is provided for informational and/or educational purposes. This material represents the views and opinions of its authors and should not be construed as representing or reflecting the official position, views or opinions of the Society of Laparoscopic & Robotic Surgeons. The authors of the work are solely responsible for its content.

COVID-19 has drawn many aspects of medicine into a different focus. Now, months after the pandemic made its initial impact on our hospital, we are able to reflect on all the adjustments made, how they’re working and what the future might look like. As a urologist, it’s clear that one particularly beneficial part of my armamentarium is my advanced laser. Surgeons in other fields who have upgraded their laser to the latest-generation technologies and applications have had similar realizations.

HoLEP for enlarged prostate — I perform holmium laser enucleation of the prostate (HoLEP) for treatment of benign prostatic hyperplasia (BPH). Using the second-generation 120 watt holmium laser that optimizes the “MOSES effect” I achieve enhanced hemostasis and therefore have shortened operative time. This has permitted many patients to be discharged the same day. By following an outpatient model, we reduce patients’ exposure in the hospital while lowering costs.

Patients with very large prostates who would have required open or robotic simple prostatectomy and a hospital stay can now have HoLEP, which is indicated for prostates of all sizes. What’s more, HoLEP has an excellent retreatment rate (about 1%, compared to about 17% for TURP¹). Even high-risk patients who are most concerned about going to the hospital in today’s environment can get effective treatment, go home the same day, and likely never require additional surgery for BPH.

Airway surgeries — Daniel Fink, MD, is an Assistant Professor of Otolaryngology at the University of Colorado School of Medicine and a surgeon at National Jewish Health in Denver. Dr. Fink, who specializes in voice, swallowing and airway disorders, sees the value of his CO₂ laser for improving COVID-19 safety in the OR. “For airway work, it has been very useful to have a CO₂ laser system with the ability to switch from a line-of-sight surgical approach where patients are intubated to a fiber-based approach. This dual modality in a single platform is advantageous because versatility allows me to easily pivot without the need for two laser systems on standby, saving the hospital money. Currently, I’ve found that using a flexible bronchoscope and a laser fiber through a laryngeal mask airway, creating a closed system that reduces potential aerosols, minimizes the risk of spreading coronavirus in the OR,” he explains.

Complex laparoscopic pelvic surgeries — “The advanced CO₂ laser allows me to be more precise and surgically meticulous when performing complex laparoscopic surgery, such as for severe pelvic endometriosis disease,” says Vadim V. Morozov, MD, FACOG, FACS, a gynecologic surgeon specializing in management of chronic pelvic pain, endometriosis, and minimally invasive gynecologic surgery at MedStar Health in Washington, DC and Maryland. “That high level of control allows me to work faster because I have less chance of injuring sensitive organs. This reduces operative time, which in turn ensures that OR personnel experience less overall exposure to potential pathogens, including coronavirus. The precision helps potentially eliminate intra- and postoperative complications related to the use of energy. Moreover, patients have a quicker recovery and less post-op pain, shortening the time they spend in the recovery room after the surgery.”

The very same advantages of advanced lasers that help lower patients’ potential exposure to the coronavirus also offer clinical advantages that make them wise choices for the future. Used appropriately, they are even helping us reduce aerosol exposure in the OR, a risk we were already working to mitigate before COVID-19. Going forward, we will continue to learn and evolve in ways that best serve our patients while protecting surgeons and staff.

Reference
1. Abedi A, Razzaghi MR, Rahavian A, et al. Is Holmium Laser Enucleation of the Prostate a Good Surgical Alternative in Benign Prostatic Hyperplasia Management? J Lasers Med Sci. 2020 Spring; 11(2): 197–203.

The content presented on this page is provided for informational and/or educational purposes. This material represents the views and opinions of its authors and should not be construed as representing or reflecting the official position, views or opinions of the Society of Laparoscopic & Robotic Surgeons. The authors of the work are solely responsible for its content.

RAYMOND J. LANZAFAME, MD, MBA, FACS NAMED AS CHAIRMAN OF THE SOCIETY OF LAPAROSCOPIC & ROBOTIC SURGEONS (SLS)

Miami, FL: The Society of Laparoscopic & Robotic Surgeons (SLS) is pleased to announce the appointment of Raymond J. Lanzafame, MD, MBA, FACS to the position of Chairman. Dr. Lanzafame has been a key part of SLS’s success since joining the Society in 1992. He continues to serve as the Society’s Executive Director and Scientific Program Chair.

Dr. Lanzafame is certified by the American Board of Surgery. He received a Bachelor of Science with Honors and Distinction from Cornell University, an MD from George Washington University, and an MBA from the William E. Simon School of the University of Rochester.

He holds 24 organizational memberships including: Society of University Surgeons, SAGES, and Central Surgical Association. He is Executive Editor of Photobiomodulation Photomedicine and Laser Surgery, on Editorial Boards for General Surgery News, Journal of Laparoendoscopic Surgery (JLAST), Journal of the Society of Laparoscopic and Robotic Surgeons (JSLS), Lasers in Surgery and Medicine, and Lasers in Medical Science. He is past president of the Upstate Chapter American College of Surgeons, American Society for Laser Medicine and Surgery (ASLMS), and The North American Association for Photobiomodulation Therapy (NAALT). He Chairs the ANSI Z136.3 Safe Use of Lasers in Health Care 2019 Revision Committee, delivered testimony on device regulation, participates national panels on lasers and laser safety, credentialing, laparoscopy, managed care, performs medicolegal and biotech consulting, and is consultant to the General and Plastic Surgery Devices and Medical Devices Advisory Committee panels of FDA-CDRH. His publications include over 250 scientific papers and 4 textbooks. He received numerous awards, has 8 Who’s Who listings, and is Director of CME for ASLMS.

The Society of Laparoscopic and Robotic Surgeons Is a non-profit, multidisciplinary and multispecialty educational organization established in 1990 to improve patient care and promote the highest standards of practice through education, training, and information distribution. SLS provides a forum for the introduction, discussion and dissemination of new and established ideas, techniques, technologies and therapies in laparoscopic, endoscopic, robotic, and minimally invasive surgery. SLS is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The goals of minimally invasive surgery remain the same as laparoscopy – achieve the desired outcomes with less destruction, pain and recovery time – but the methods of achieving those goals have evolved over time. Here, the pioneer and inventor of modern day minimally invasive and robotic surgery, Camran Nezhat, MD, FACOG, FACS, weighs in on how he’s advancing these goals in 2020 and beyond.

You have spent decades helping to develop highly effective, minimally invasive surgical procedures. What current endoscopic/laparoscopic technologies do you find most beneficial to those goals?
Laparoscopes, cameras and robots have improved greatly over the years, allowing better visualization. The ability to see the surgical field and pathology better intraoperatively greatly improves the surgeon’s ability to perform safe surgery and reduce complications.

I also use a robotic system (da Vinci Surgical System, Intuitive Surgical) and the carbon dioxide laser (UltraPulse CO2, Lumenis), which can be used for precise excision of endometriosis, hemostasis, improved visualization, less tissue damage, and fewer complications compared to other alternatives. One of the greatest benefits is the limited thermal injury because we know that thermal spread can cause immediate and delayed injuries. With a carbon dioxide laser, the thermal damage on the target tissue is typically about 150 microns, compared to 3000-7500 microns with electrocautery. The more precise the energy source, the less morbidity occurs.

In addition, hydrodissection can be employed during laparoscopic surgery. This technique places fluid underneath the peritoneum and pushes vital structures like the ureter away from the operative field, thus helping preserve those tissues.

Historically, it has been particularly difficult to completely remove endometriosis cells, which can be widespread and grow on or near the ovaries, bowel and diaphragm. How can you treat every trace of endometriosis while preserving the adjacent tissues?

What the mind doesn’t know, the eyes don’t see. To effectively treat endometriosis, one must first be able to appropriately suspect the disease is present, and then be able to spot abnormalities laparoscopically, even if they are subtle. In addition to advances in laparoscopes and cameras, decades of experience treating this disease has given me the opportunity to learn about all of the variations in disease presentation as well as the ability to see every trace of endometriosis that may not be obvious to the less trained eye.

Having the right equipment and using it appropriately is also essential for thorough treatment and maximum preservation of fertility. For example, when superficial spots of endometriosis are found on the ovary, I favor using the irrigator to wash the ovary or very gently scraping the ovary instead of incising or cauterizing the ovaries. This protects the ovary from injury and avoids compromising ovarian reserve. In general, I am very cautious and use little or no energy or heat around the fallopian tubes and ovaries.

How do minimally invasive surgeries continue to improve postoperative pain, complications and recovery time?

We know minimally invasive techniques have multiple benefits for patients including smaller incisions, less blood loss, less adhesion formation, fewer wound infections, less complications, shorter hospital stays, faster recovery, and less cost. We have advocated for these techniques for decades. Postoperative pain and recovery time have continued to decrease as minimally invasive surgery has become more widespread and more efficient.

Minimally invasive surgery relies strongly on skill and precision. How do you approach complex surgeries with care, while at the same time maintaining a level of efficiency?

The more efficient the surgeon can be, the less time the patient will be under anesthesia, leading to better patient outcomes. The best solution is to proceed with surgical precision and to have a good understanding of anatomy. Minimizing extraneous movement intraoperatively can decrease surgical time, which generally leads to improved patient comfort and faster recovery as well. Another way to improve efficiency in the operating room is to use the same surgical team. Operating is a team effort, and like dancing, having the same partners each time can help us work more efficiently and improve the outcome. Finally, every surgeon should be familiar with the advantages and disadvantages of every instrument and product that he/she uses to maximize its benefit for the patient.

The content presented on this page is provided for informational and/or educational purposes. This material represents the views and opinions of its authors and should not be construed as representing or reflecting the official position, views or opinions of the Society of Laparoscopic & Robotic Surgeons. The authors of the work are solely responsible for its content.

Here in rural southwest Oregon, I am the only general surgeon in my county. It’s a challenging position that keeps me on my toes. Because there can be unexpected demands on my time, I need to work as efficiently as possible. That means keeping an eye out for new advances that can save time, make surgery go more smoothly, and reduce stress on my body. One side benefit: some technologies simplify OR staffing by elevating less-skilled assistants.

For example, I use the ClickClean, an in-abdomen laparoscope lens cleaning device (Medeon). It covers the scope in a transparent sheath, and when fluids or smoke obstruct my view, I click the trigger to advance clean, new film over the lens. The device is designed to give surgeons a clear, consistent view, while saving time and frustration, but because we don’t need to pause surgery, remove the scope, clean it, and get it repositioned, the efficiency of surgery no longer hinges on the assistant’s skill level.

Taking the camera out over and over again is annoying regardless of the assistant’s skill level, but it’s certainly easier with an assistant who is experienced in laparoscopic surgery, understands anatomy, and knows how we need to orient the scope. My assistants are usually medical students, but if none are available, my scrub tech handles the scope. If my assistant is not very experienced, I usually have to put my instruments down, clean the camera, reinsert it, and hand it back to the tech or medical student.

High-quality Microline Surgical laparoscopic instruments also reduce the skill level required of my staff, and they give me added peace of mind. For example, with a good laparoscopic grasper, it’s easy for me to firmly grasp the gallbladder and have an assistant hold the grasper and retract the liver while I continue dissection. I can proceed with confidence knowing that the grasper will not fail while the assistant is holding it.

In addition, a high-definition laparoscopic camera and 4K flat screen display (Stryker) not only help me to see better, work more safely, and reduce strain, but also help my OR staff learn the procedure and work more efficiently. Medical students can clearly see what I’m teaching them. At the same time, other staff members gain a better understanding and learn to anticipate what comes next, so the entire process go more smoothly. Inexperienced staff can learn and build their skills more quickly, so we’re raising the skill level of the pool.

All of my ergonomic choices in the OR help our staff as well. To minimize the toll that long hours of surgery take on my body, I make sure the table is at the right height, the screens are positioned just right, and cushioned handpieces make tasks less fatiguing. Staff members have less fatigue as well, and the positioning makes it easier for them to assist. For example, a technically challenging laparoscopic dissection is made easier if the ergonomics are favorable. This cuts down frustration during a difficult case.

With help from these technologies and our OR staff making surgery more efficient, I’m able to do a long day of elective cases and still be on call 24/7, responding to emergencies from the ER. I don’t always know who will be available to assist in the OR, but I’m confident that no matter who is helping, we will always provide the best care.

The content presented on this page is provided for informational and/or educational purposes. This material represents the views and opinions of its authors and should not be construed as representing or reflecting the official position, views or opinions of the Society of Laparoscopic & Robotic Surgeons. The authors of the work are solely responsible for its content.

By Kenny R. Sinervo, MD, FRCSC

Endometriosis is a progressive condition where endometrium-like tissue grows outside the uterus in the pelvis, abdomen and thorax. The condition causes chronic pain, inflammation, endometriomas, fibrosis, adhesions, bowel or bladder dysfunction, endocrine and immune problems and infertility. Endometriosis affects 0.7% to 8.6% of women, including 15.4% to 71.4% of women who present with pelvic pain and 9.0% to 68.0% of women experiencing infertility.¹

As a specialist in endometriosis, I see how patients are mistreated in both senses of the word. First, doctors frequently misunderstand and dismiss their complaints. The result is often repeated misdiagnosis, unnecessary treatments, and years of frustration and doubt.

When patients do get an accurate diagnosis, they are most likely to be mistreated clinically. Doctors prescribe birth control pills that just reduce the severity of symptoms. Some patients are told, “Let’s just wait until you’re ready to have kids, and then we’ll do your surgery.” In the intervening decade, endometriosis continues to progress. I see many patients who were diagnosed in their teens and placed on birth control pills, and when they come off the pill 10 or 12 years later, they are in severe pain and cannot conceive.

Endometriosis is also treated with several surgical options. For patients who do not want to conceive, hysterectomy is an aggressive approach. However, the surgery alone does not eliminate the disease or its symptoms. If the ovaries are removed, 10% of patients still have chronic pain; that number jumps to 60% if the ovaries remain.^2,3

More common today are two conservative approaches to surgery. Ablative procedures, which include cauterization, laser vaporization, or harmonic scalpel ablation of the endometria, are performed by the great majority of gynecologists. Unfortunately, these surgeries only treat the surface of the problem while leaving behind the root, so the recurrence rate for endometriosis after ablation is 60% to 80% within 2 years.^4,5 Thus, the likelihood of long-term fertility improvement is low.

The second, more effective conservative surgery for endometriosis is excision. In excision, we make an incision around the tissue and remove the full depth of the disease. This can be done with scissors and/or a CO₂ laser. I use the CO₂ laser (Lumenis UltraPulse Duo CO₂) because it causes minimal damage to adjacent tissue and simultaneously cauterizes, so I can work more efficiently and have better visualization.

In my practice, this approach limits the recurrence rate to less than 10%. The procedure is technically more difficult than ablation, but it allows us to safely excise tissue from delicate structures such as the ovaries, ureters, bowels and bladder. About 80% of my patients want to get pregnant, and a 10% recurrence rate makes that much more likely compared to ablation. As we follow these patients, their fertility rates seem to decline at normal rates based on maternal age.

If women with endometriosis were asked, “Would you rather have surgery with less than 10% chance of recurrent pain or one with a 60% to 80% chance?” they would choose excision. But not all surgeons perform excision, and they do not present that option to patients.

Instead, patients have multiple ineffective ablative surgeries, one after the other, often with complications such as retroperitoneal fibrosis. By the time patients get to me, most have had three or four unsuccessful ablative surgeries and just as many failed medical treatments. Despite those challenges, they are still good candidates for excision, and about 85% have significant improvement in pain after surgery. But they deserved better from the start. Surgeons must stop mistreating endometriosis, and they can do that by recognizing the condition early and using surgical excision for first-line treatment.

1. Ghiasi M, Kulkarni MT, Missmer SA. Is Endometriosis More Common and More Severe Than It Was 30 Years Ago? J Minim Invasive Gynecol. 2020 Feb;27(2):452-461.
2. Rizk B, Fischer AS, Lotfy HA, et al. Recurrence of endometriosis after hysterectomy. Facts Views Vis Obgyn. 2014; 6(4): 219–227.
3. Namnoum AB1, Hickman TN, Goodman SB, Gehlbach DL, Rock JA. Incidence of symptom recurrence after hysterectomy for endometriosis. Fertil Steril. 1995 Nov;64(5):898-902.
4. Yeung P Jr, Sinervo K, Winer W, Albee RB Jr. Fertil Steril. Complete laparoscopic excision of endometriosis in teenagers: is postoperative hormonal suppression necessary? 2011 May;95(6):1909-12, 1912.e1.
5. Bozdag G. Recurrence of endometriosis: risk factors, mechanisms and biomarkers. Womens Health (Lond). 2015 Aug;11(5):693-9.

The content presented on this page is provided for informational and/or educational purposes. This material represents the views and opinions of its authors and should not be construed as representing or reflecting the official position, views or opinions of the Society of Laparoscopic & Robotic Surgeons. The authors of the work are solely responsible for its content.

SLS staff and leadership have reached this difficult decision after careful consideration of the evolving nature of this highly fluid situation with prolonged travel restrictions or bans and ongoing health-related concerns related to the COVID-19 Pandemic. Our top priority remains the health and safety of all participants at MISWEEK2020, including attendees, faculty, industry partners, staff, vendors, and others involved with our Annual Conference.

We are investigating alternatives to bring the essence of MISWEEK to you and we invite you to visit www.sls.org where we will continue to provide information and updates and to view the array of content that is available

If you have any questions, please contact the SLS Office at Info@SLS.org.

Thank you for all that you are doing to mitigate this threat and care for patients. We look forward to more pleasant times and the ability to return to face to face gatherings soon.

Stay safe and stay well!