Resident’s surgical video wins international conference award
Second-year ob-gyn resident Kevin Kuan is recognized as best young investigator for robotic surgery video
Kevin Kuan, a second-year ob-gyn resident, won the Top Video Abstract award for young investigators at the Society of Endometriosis and Uterine Disorders (SEUD) international conference in Frankfurt, Germany.
The winning video demonstrated a complex procedure performed using robotic surgery, a retroperitoneal myomectomy, in a patient suffering from severe endometriosis. The surgery removed retroperitoneal fibroids (rare benign tumours) that had developed outside the uterus.
The video, "A robotic approach for retroperitoneal myomectomies in the context of severe endometriosis," was co-authored by Ana Iancu, an ob-gyn fellow, and Jamie Kroft, an associate professor in the department and the project’s supervisor. Kroft, who performed the surgery in the video, is on staff at Sunnybrook Hospital.
Writer Matthew Tierney reached out to Kuan to ask about the surgical procedure, the video production and his experience at the conference.
Why did you produce a video for this particular procedure?
A retroperitoneal myomectomy is a difficult surgery. In most Ontario centres, it would have been performed using traditional laparoscopy. The reason for that is governmental funding for robotic surgery in gynaecology is limited to endometrial cancer-related hysterectomies with high BMI. We were fortunate that Sunnybrook has the funding to utilize robotic surgery for other complex gynaecology cases, such as fibroids or endometriosis, and thought this would be a good opportunity to showcase the benefits of this technology.
We documented our approach to robotic myomectomies for two large retroperitoneal fibroids. There happened to be two fibroids in our video, but they are very rare as they are normally found attached to the uterus, not outside.
What were the takeaways from the surgery?
Endometriosis is a complex disease. At the start of the surgery, there were so many adhesions that the pelvic anatomy was completely obstructed and made for poor visualization. A significant duration of the surgery involved careful dissection of the endometriosis to restore pelvic anatomy. We really wanted to stress the importance of this step, especially in these cases, to mitigate risks for damage to nearby crucial structures that may be distorted from endometriosis.
One aim in the video was to highlight the better surgical articulation of the instruments that the robot allows for. For example, forward needle-driving in very low, posterior locations of the pelvis was easier to achieve than with laparoscopy. We also showed the importance of detailed preoperative imaging for surgical planning.
This was my first surgical video. One of the steepest learning curves was determining how to condense a seven-hour surgery into a short five-minute video. What helped me was making sure the clips focused on the video’s primary objectives and learning goals.
Surgery is all about finding new ways to improve techniques, and I look forward to making more videos. Hopefully, this video makes the case for more robotic surgery funding for such complex cases.
How was the experience of presenting at the conference?
I was so honoured to showcase this video at SEUD, an incredible, forward-thinking conference that devotes many presentations to novel surgical techniques. I also had a chance to connect with my collaborators from McMaster and the University of Edinburgh.
Being able to highlight the surgical excellence in Toronto on an international scale was very rewarding — the moderators acknowledged that they could see how skillful Dr. Kroft was as she performed the surgery. I am incredibly grateful for the mentorship from Dr. Kroft and Dr. Iancu throughout.
My research interests are in endometriosis and chronic pelvic pain. There is so much we need to learn: from recognizing symptoms, reducing delays in diagnosis, to multidisciplinary long-term management. Hopefully this presentation is just the first of many I will make in this area throughout my career.
