Publications
Single incision laparoscopic surgery (SILS) in gynaecology: Feasibility and operative outcomes.
Aust N Z J Obstet Gynaecol. 2012 Aug; 52(4):366-70. doi: 10.1111/j.1479-828X.2012.01443.x. Epub 2012 Apr 30.
Behnia-Willison F, Foroughinia L, Sina M, McChesney P.
Source: Obstetrics & Gynaecology, Flinders Medical Centre, Adelaide, South Australia, Australia.
Abstract
BACKGROUND:
Single incision laparoscopic surgery (SILS) represents the latest advancement in minimally invasive surgery, combining the benefits of conventional laparoscopic surgery, such as less pain and faster recovery, with improved cosmesis. Although the successful use of this technique is well reported in general surgery and urology, there is a lack of studies on SILS in gynaecology.
AIMS:
To evaluate the feasibility, safety, cosmesis and outcome of SILS in gynaecology.
METHODS:
A prospective case series analysis of 105 women scheduled to undergo surgery by SILS from August 2010 to November 2011. Intra-operative data such as operative time, estimated blood loss, complications, additional ports and hospital stay were collected. Post-operative pain and cosmetic outcomes (scar size) were also recorded.
RESULTS:
Out of 105 women, SILS was performed for 84 (60 excisions of endometriosis, 13 divisions of adhesions, five hysterectomies, two mesh sacrohysteropexies and four ovarian cystectomies). SILS was not undertaken for 21 women because of a number of factors, including the lack of required equipment (eg bariatric scope, SILS port, roticulating instruments and diathermy leads). Four women required insertion of additional ports because of surgical difficulties. One intra-operative (uterine perforation) and seven post-operative complications (six wound infections and one vault haematoma) occurred. Mean operation times were as follows: mesh sacrohysteropexy - 60 min, excision of endometriosis - 55 min, hysterectomy - 150 min, laparoscopic division of adhesions - 62 min and ovarian cystectomy - 40 min.
CONCLUSIONS:
Our experience shows that SILS is a feasible and safe technique for the surgical management of various gynaecological conditions. Satisfaction is high because of improved cosmesis and reduced analgesic requirements post-operatively.
© 2012 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
PMID: 22548311 [PubMed - in process]
Perspectives of Laparoscopic Donors Towards a New Procedure:
Transvaginal Donor Nephrectomy
JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES
Volume 20, Number 10, 2010 ª Mary Ann Liebert, Inc. DOI: 10.1089/lap.2010.0291
Santosh Antony Olakkengil, MBBS, DNB (Gen Surg), M.MinInvSu (Aus), FIAGES,Michael G.A. Norwood, MB ChB, FRCS, MD, M.MinInvSu, Andrew D. Strickland, BMedSci, BM BS, MD, FRCS (Gen Surg), M.MinInvSu, Fariba Behnia-Willison, FRANZCOG, MRANZCOG, MBBS, Manchala Mohan Rao, MS, MCh, FACS, FRACS, and Peter J. Hewett, MBBS, FRACS
Abstract
Background: Interest in natural orifice transluminal endoscopic surgery (NOTES) is increasing. Transvaginal NOTES (TVNOTES) donor nephrectomy with subsequent removal of the kidney via the vagina is technically possible. This approach may minimize the surgical insult to the donor and allow improved cosmesis. The acceptability to patients of such a technique is, however, unknown. The aim of this article is to explore the attitudes of women who have previously undergone laparoscopic donor nephrectomy (LDN).
Methods: A 15-point questionnaire was designed by a multidisciplinary group of surgeons interested in minimally invasive surgery to obtain the views of women who had previously undergone LDN at the QueenElizabeth Hospital, Adelaide. It was sent to 150 female donors, and their views with regard to the acceptability of a TV approach to the peritoneal cavity for donor nephrectomy were recorded.
Results: Forty-nine patients returned the completed questionnaire. The majority (90%) of these women did not
have adverse feelings toward scars. Thirty-seven percent of women would consider a TVNOTES donor nephrectomy; however, this was increased to 51% if they could be reassured that TVNOTES was as safe as LDN.Concerns regarding a negative impact on sexual function after this procedure were raised by 33% of patients. The majority (88%) did not cite surgeon gender as an important factor when deciding for or against this procedure.
Conclusions: This study demonstrates that less postoperative pain, better cosmesis, and safety are factors that may influence a patient’s decision to choose TVNOTES donor nephrectomy. The majority, however, would still prefer LDN.
Transvaginal Natural Orifice Translumenal Endoscopic Surgery (NOTES), a survey of women’s views of a new technique.
Strickland AD, Norwood MGA, Behnia-Willison F, Olakkengil SA, Hewett PJ., University of Adelaide Departments of Surgery, Renal Transplant and Gynaecology, Queen Elizabeth Hospital, Woodville Road, Woodville, Adelaide, South Australia. 5011
Abstract
Background : Laparoscopic and minimally invasive surgery has changed the surgical landscape irrevocably. NOTES (Natural Orifice Translumenal Endoscopic Surgery) offers the possibility of surgery without visible scars. Transvaginal entry offers potential benefits as access to the peritoneal cavity can be gained without need to open an abdominal viscus. Much of the discussion pertaining to NOTES focuses on technical and training issues with little attention so far paid to the opinions of women. The perceptions of female healthcare workers, and patients were sought in relation to their views towards transvaginal NOTES.
Materials and Methods: Three hundred women were surveyed using a twelve point questionnaire devised by a multidisciplinary group of surgeons interested in minimally invasive surgery. The questionnaire was designed to establish the opinions of women with respect to NOTES surgery and its comparison to standard laparoscopic procedures. Responses were de-indentified.
Results: Three quarters of those surveyed were neutral or unhappy at the prospect of a NOTES procedure and this remained constant even when it was stipulated that laparoscopic cholecystectomy and NOTES had equivalent safety and efficacy. Younger, nulliparous women were most concerned with the potential negative effect on sexual function. A minority were concerned with the cosmetic effect of surgery although surgical scars were perceived more important in younger respondents.
Conclusions: NOTES surgery has the potential to offer women a scarless operation with the possibility of less pain than standard laparoscopic surgery. Few women were however troubled about the cosmetic effect of surgery. The effect of NOTES on sexual function was expressed as a particular concern by younger women. In all groups and across all ages peritoneal access using the transvaginal route was met by significant scepticism. In Australia, women remain to be convinced of the potential advantages of emerging NOTES technology.
Laparoscopic Management of Prolapse and Stress Urinary Incontinence
Publisher: Jaypee Brothers Medical Publishers (P) Ltd. (December 1, 2008)
ISBN-10: 818448139X
Chapert 25. Newer Concepts in Vaginal Procedures in Reconstructive Surgery
Elvis I Seman, Fariba Behnia-Willison, Jennifer R Cook, Robert T O'Shea
Intra-operative Ultrasonography Evaluation of Risk of Malignancy Index in Ovarian Cysts
Fariba Behnia-Willison, FRANZCOG, MRANZCOG, MBBS,
Peter J. Hewett, MBBS, FRACS,Mehrnoush Sarmadi, MD, Amirreza Jourabchi, MD, AFCHSM
Purpose: The aim of the study was to compare intra-operative, Laparoscopic/Laparatomic Ultrasonography with pre-operative Transvaginal or Abdominal Ultrasonography for the evaluation of the Risk of Malignancy Index (RMI) in the ovarian cysts. We expected to have a more accurate and sensitive intra operative RMI and more accurate estimation of the ovarian cyst size which could result in more appropriate surgical approach and reduction of Intraoperative Frozen Section sampling.
Methods and Materials: 5 women who underwent surgical management of their ovarian cysts were included. An ultrasonic probe was placed over the surface of ovarian cyst and pictures were captured and saved for later evaluation. The results of intra-operative and pre-operative RMI were compared and the accuracy of two method were evaluated with final histopathology result.
Results: Of 7 patients 5 had intra operative ultrasonography at the time of the procedure. One woman with moderate RMI, was found to have border-line ovarian cyst at the time of frozen section and histopathology examination while intra-operative RMI was higher than pre- operative one .One of them had low RMI pre and intra-operative with histopathology of benign cystadenoma.Tree of them had moderate RMI pre-operatively and intra-operatively. It was noted that in the ovarian cyst more than 9 cms the accuracy of vaginal ultrasound was less than intra-operative ultrasound.
Conclusion: The intra-operative ultrasound is undervalued and not readily used in ovarian cysts evaluation. As vaginal ultrasound has limitation when the cyst is more than 5 cm. Intra- operative ultrasound can accurately evaluate the cysts more than 5 cm in terms of abnormal features. As well as the limitation of BMI can be overcome by intra-operative ultrasound. It appears that intra-operative ultrasound has a place in the management of ovarian cyst but more studies are needed to confirm its usefulness in ovarian cysts management.
This research certified as Master of Minimally Invasive Surgery for Dr Fariba Behnia-Willison.
Laparo-vaginal approach to the anterior vaginal wall prolapse repair
Behnia-Willison F, Seman EI, Cook JR, O’Shea RT, Keirse M
Journal of Minimally Invasive Gynaecology, 2008
A Design Approach for Feedback-feedforward Control Systems
Mohammadzaheri M, Chen L, Behnia-Willison F, Aryan P
The 7th IEEE International Conference on Control and Automation, Christchurch, New Zealand, 9-11 December, 2009.
Double-Command Feedforward-Feedback Control of a Nonlinear Plant
Mohammadzaheri M, Chen L, Behnia-Willison F, Askarian S
The 7th IEEE International Conference on Control and Automation, Christchurch, New Zealand, 9-11 December, 2009.
Double Command Model-Free Hybrid Control of a Nonlinear CSTR
Mohammadzaheri M, Atrinejad H, Kasaee Kopaei M, Behnia-Willison F
The 2nd International Conference on Computational Intelligence, Modeling and Simulation (IEEE sponsored). Bali, Indonesia, 28-30 September, 2010.
Assessment of a method to expel intraperitoneal gas after gynecologic laparoscopy
Thomson AJ, Abbott JA, Lenart M, Willison F, Vancaillia TG, Bennett MJ
Journal of Minimally Invasive Gynaecology 12(2):125-9, 2005
Reply to Drs McMaster-Fay and Jones
Cook JR, Seman EI, O’Shea RT, Willison F
Australian and New Zealand Journal of Obstetrics and Gynaecology 44(5):483-4, 2004
Morbidity associated with laparoscopic surgery in benign gynaecological surgery
Behnia-Willison F, Abbott JA, Thomson AJ, Lenart M, Vancaillie TG
Australian and New Zealand Journal of Obstetrics and Gynaecology (pending)
SILS and Pelvic Floor Repair, Case Presentation and Video
F. Behnia-Willison, A. Jourabchi, P. Hewett, Ashford Hospital/Flinders University, South Australia
AGES Pelvic Floor Symposium XII, Adelaide, South Australia, 3 & 4 June 2011
Single Incision Laparoscopic Surgery (SILS) is a new method of laparoscopic surgery in gynaecology. This procedure enhances the benefits of traditional laparoscopic surgery such as decreased blood loss and minimal postoperative pain. It also promotes a faster recovery process and has more cosmetic advantages.A total number of 45 SILS operations have been carried out in South Australia since 2009. For the first time in Australia, laparoscopic mesh sacrohysteropexy has been performed in with SILS method in Ashford Hospital.
The video presentation shows mesh sacrohysteropexy with SILS method on a 70 year old patient with Global Prolapse Stage II. This surgery has been done through a single incision on the umbilicus. It lasted for about 55 minutes. It was uneventful and after 6 weeks the site of the surgery was scarless and the patient was satisfied with the results of the surgery.
The aim of this study is to demonstrate the feasibility and safety of SILS in mesh sacrohysteropexy in vaginal prolapse.
A Prospective Study of Elevate Mesh Kit in Pelvic Floor Repair
F. Behnia-Willison, L. Foroughinia, A. Jourabchi, M. Sarmadi, Flinders Endogynaecology Unit
AGES Pelvic Floor Symposium XII, Adelaide, South Australia, 3 & 4 June 2011
Pelvic organ prolapse (POP) is a common condition in females worldwide.We conducted a prospective study of more than 200 patients undergoing PFR for POP. All patients underwent urodynamics study and pre-operative POPQ assessment prior to the operation.
We evaluated the prolapse intra-operatively (Barber MD et al., 2009) to determine whether to use Elevate Mesh Kit, Surgisis or native tissue. Post-operative follow up visits were conducted at six weeks and then yearly, with success of each procedure measured using POPQ. Furthermore, intra-operative and post-operative complications were recorded and pre- and post- operative sexual function questionnaires were completed by patients.
