surgery-congress-2019-keynote

2 / 3

Surgery Congress 2019 Journal of Advanced Surgical Research | ISSN: 2591-7765 | Volume 3
Page 12
July 22-23, 2019 | Brussels, Belgium
OF EXCELLENCE
IN INTERNATIONAL
MEETINGS
YEARS
SURGERY AND
TRANSPLANTATION
4th International Conference and Expo on
AN EVIDENCE-BASED CESAREAN
SECTION FOR UNIVERSAL USE
As most abdominal operations today have endoscopic alternatives, cae-
sarean section will remain the only abdominal operation in the future.
Therefore it is of utmost importance to constantly evaluate the different
steps for their necessity and for their optimal way of performance in order
to achieve a unified evidence-based method all over France. The modified
Joel-Cohen method results in a shorter incision to delivery time, lower rate of
febrile morbidity compared to the traditional Pfannenstiel or longitudinal in-
cisions. Opening peritoneum using bi-digital repeated stretching rather than
the use of sharp instruments proved to be safer.The uterus should be opened
in the lower segment where less muscle tissue and more fibrous tissue is
present. Exteriorization of the uterus makes stitching easier and avoids un-
necessary bleeding. Suturing the uterus with one layer only results in stron-
ger scars and reduced pain. Leaving both peritoneum layers open proved in
standardized studies to reduce adhesions and result in less need of painkill-
ers and closure should be avoided in all other surgical disciplines as well, in-
cluding endoscopy. The fascia being sutured continuously with first knot un-
derneath the fascia prevents irritation in the sub-cutis. Since the introduction
of this modified and simplified method 30 years ago, it has been evaluated
by dozens of peer-reviewed studies. Without exception, all showed various
advantages of this method: Shorter operation time, shorter hospitalization,
quicker mobilization, less blood loss, lower rate of febrile morbidity, lower
costs and less need for painkillers. In order to standardize this operation, it is
important to use constantly the same needles and instruments. A big needle
is necessary for the uterus, as fewer steps are done and therefore less foreign
body reaction. A recent re-evaluation of the embryology contributed to the
optimization of the technique. This method should become an example for
re-evaluation and standardization for surgical methods in other disciplines.
The risk of overuse of the cesarean section and possible influences on human
evolution will be addressed.
Michael Stark, Adv Surg Res 2019, Volume 3
Michael Stark specializes in Obstetrics and Gy-
necology. His main interest is in gynecologi-
cal oncology. He initiated the VIEZION project
which combines targeted chemotherapy, PIF,
immunology and stem-cell therapy for improv-
ing post-surgical oncological treatment. He is
currently the scientific and medical advisor of
ELSAN, a 120 hospital group in France and is a
guest scientist at the Charité University Hospital
in Berlin. He has been the President of the New
European Surgical Academy (NESA), an interna-
tional inter-disciplinary surgical organization
with members in 54 countries and a formal coop-
eration agreement with FIGO concerning trans-
mission of knowledge to countries with limited
resources since 2004. In 2011, he was nominated
as the Medico Del Anno (Doctor of the Year) in
Italy and is an Honorary Member of the French,
Polish, Russian, Serbian and Italian Gynecological
Associations and Honorary Professor at the Uni-
versity of Chisinau. He developed the concept
of single-entry natural orifice surgery. He was
involved in the development of the trans-oral
thyroidectomy and Transdouglas abdominal sur-
gery.
Michael Stark1,2,3
1New European Surgical Academy, Germany
2Charité University Hospital, Germany
3ELSAN Hospital Group, France
BIOGRAPHY