Richard H. Demir, MD  Director of Ultrasound, Gynecology & Obstetrics - Desert Women’s Care President -Society of Elite La...
<ul><li>Richard H. Demir, MD </li></ul>This program summarizes key aspects of Dr. Demir’s ongoing activities <ul><li>This ...
Clinical Activities DWC… We care about patients!
Dr. Demir is proud of his commitment to Minimally Invasive Surgical principals and offers the most sophisticated procedure...
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>What drives the push toward Minimall...
X
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>Gynecologists  compared to other sur...
DWC Minimally Invasive Surgery Program
Dr. Demir and DWC offer a full team commitment to performing and successfully completing even the most complex procedures ...
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>As the Director at DWC, Dr. Demir as...
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<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>PELVIC RELAXATION
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>Pelvic Relaxation <ul><li>Most often...
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>Anterior Compartment Defect with Str...
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>Anterior Compartment Defect with Str...
<ul><li>Laparoscopic Paravaginal Repair </li></ul><ul><li>In photo 1 the bladder is filled and anterior margin identified ...
urethra bladder Dome of the Foley catheter Sutures suspend paravaginal tissue
 
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>Anterior Compartment Defect with Str...
 
Uretex® TO Trans-Obturator Urethral Support System Twenty Minute Repair for Stress Urinary Incontinence
TransObturator Approach as effective as open abdominal surgery with 1 – 2 day recovery time and virtually no time off work...
X
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>ADNEXAL PATHOLOGY & FIBROIDS
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>Adnexal Masses and Fibroids can be t...
Pedunculated sub-serosal uterine myoma is clearly demonstrated at laparoscopy
Myoma is attached to the uterus on a stalk that is clearly identified
Once free within the abdominal cavity the myoma is morcellated and removed in long fragments
Excision of this myoma leaves a denuded area that is covered with an anti-adhesive barrier prior to concluding the procedure
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>Benign Ovarian Tumors can also be re...
Ultrasound demonstrates an abnormal mass within the ovary
The same mass is demonstrated on laparoscopy
Mass is removed and bleeding controlled Capsule is opened and mass shelled out Capsule of ovary is closed with absorbable ...
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>Benign Ovarian Tumors <ul><li>The ab...
 
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>HYSTERECTOMY & ALTERNATIVES
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>HYSTERECTOMY <ul><li>Most Common Ben...
X
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>TRADITIONAL HYSTERECTOMY <ul><li>Tot...
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>HYSTERECTOMY ALTERNATIVE <ul><li>Emb...
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>HYSTERECTOMY ALTERNATIVE <ul><li>End...
 
TM   *Based on Intent-To-Treat population  1.  Extirpated uteri data on file, ETHICON, INC.  2.  Loffer FD, Grainger D. Fi...
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>HYSTERECTOMY ALTERNATIVE <ul><li>End...
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>LAPAROSCOPIC HYSTERECTOMY <ul><li>La...
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>LAPAROSCOPIC HYSTERECTOMY <ul><li>Su...
Ultrasound demonstrates a large fibroid tumor within the myometrium
Laparoscopy clearly demonstrates the enlarged uterus with irregularity of the fundus
Ligasure device is used to divide the attachments of the uterus
The bladder is located and moved out of the way to assure it is not injured
In Supra-cervical hysterectomy, the corpus is divided from the cervical stump
Once the body of the uterus is free, it must be morcellated so that it can be removed through the “pencil-like” abdominal ...
The parietal peritoneum is sewn over the cervical stump sealing the abdominal cavity
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>LAPAROSCOPIC HYSTERECTOMY <ul><li>Co...
Koh Colpotimizer Rumi Manipulator
 
 
 
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>COMPLETE LAPAROSCOPIC HYSTERECTOMY O...
<ul><li>In this case, the uterus was morcellated and the vaginal barrel is closed  </li></ul><ul><li>with a suturing devic...
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>MINIMALLY INVASIVE  HYSTERECTOMY ACO...
Early decrease from Scope Hyst (LH) Early increase from Scope Hyst (LH) Late decrease from Scope Hyst (LH)
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>So why are most hysterectomies not d...
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>GUINNESS WORLD RECORD DWC <ul><li>Aw...
 
 
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>LAPAROSCOPIC HYSTERECTOMY AT DWC <ul...
 
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>With Minimally Invasive Techniques D...
Anybody need some help here?
<ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>When compared with Robotics, DWC’s M...
DWC Multidisciplinary Pelvic Pain Program
<ul><li>CENTER FOR PELVIC PAIN </li></ul><ul><li>AT DESERT WOMEN’S CENTER </li></ul><ul><li>Multidisciplinary care for wom...
<ul><li>CENTER FOR PELVIC PAIN </li></ul><ul><li>AT DESERT WOMEN’S CENTER </li></ul>Gynecology Gastroenterology Pain Manag...
<ul><li>CENTER FOR PELVIC PAIN </li></ul><ul><li>AT DESERT WOMEN’S CENTER </li></ul><ul><li>BENEFITS TO THIS TYPE OF PROGR...
<ul><li>CENTER FOR PELVIC PAIN </li></ul><ul><li>AT DESERT WOMEN’S CENTER </li></ul><ul><li>Multidisciplinary care for wom...
<ul><li>CENTER FOR PELVIC PAIN </li></ul><ul><li>AT DESERT WOMEN’S CENTER </li></ul><ul><li>Multidisciplinary care for wom...
<ul><li>CENTER FOR PELVIC PAIN </li></ul><ul><li>AT DESERT WOMEN’S CENTER </li></ul><ul><li>Multidisciplinary care for wom...
<ul><li>CENTER FOR PELVIC PAIN </li></ul><ul><li>AT DESERT WOMEN’S CENTER </li></ul><ul><li>Multidisciplinary care for wom...
<ul><li>CENTER FOR PELVIC PAIN </li></ul><ul><li>AT DESERT WOMEN’S CENTER </li></ul><ul><li>Multidisciplinary care for wom...
<ul><li>CENTER FOR PELVIC PAIN </li></ul><ul><li>AT DESERT WOMEN’S CENTER </li></ul><ul><li>WHY WE ARE DIFFERENT </li></ul...
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Administrative Activities DWC… We care about patients!
<ul><li>ADMINISTRATIVE ACTIVITIES </li></ul>Dr. Demir is Medical Director at DWC Dr. Demir has held various administrative...
<ul><li>ADMINISTRATIVE ACTIVITIES </li></ul><ul><li>Management physicians & mid-level providers </li></ul><ul><li>Strategi...
<ul><li>ADMINISTRATIVE ACTIVITIES </li></ul><ul><li>Insurance companies have long used actuaries, attorneys, business men ...
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<ul><li>ADMINISTRATIVE ACTIVITIES </li></ul><ul><li>Patient care must be viewed in its totality to assure that all aspects...
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A full website is up and running for Desert Women’s Care. Communication with patients featuring text, photos and videos is...
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<ul><li>Philanthropic Activities </li></ul><ul><li>Demir Foundation </li></ul>
<ul><li>Demir Foundation </li></ul><ul><li>Demir Foundation was responsible for administering more than $2.5 million in im...
 
<ul><li>Demir Foundation </li></ul><ul><li>Demir Foundation also contributed to the beautification of the Elgin area with ...
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The “Raise The Flag” project returned the US flag to walton Island on the Fox River in Elgin
<ul><li>Demir Foundation </li></ul><ul><li>“ Seven at the Gates of Dawn” located at the Foundation’s park symbolized the e...
X <ul><li>“ Seven at the Gates of Dawn” </li></ul><ul><li>Elgin Image Award,  1998 </li></ul><ul><li>Elgin Cultural Arts C...
<ul><li>Demir Foundation </li></ul><ul><li>Dr. Demir continues to be proud of the Foundation’s work and the legacy of beau...
<ul><li>Raise The Flag Project </li></ul><ul><li>Flag Day Dedication,  June 14, 2002 </li></ul><ul><li>Elgin Image Award N...
Publishing DWC… We care about patients!
Dr. Demir has over twenty peer-reviewed publications including articles, abstracts, videos and book chapters. DWC… We care...
“ Laparoscopic Cervical Cerclage in 18 weeks Pregnant Uterus” was presented in June, 2010, at BICOG in Belfast, UK, and in...
Dr. Demir and Dr. Marchand won Honorable Mention GYN Video Award at 2010 Annual Meeting of Society of Laparoendoscopic Sur...
Dr. Demir won 2010 Spotlight Award from Cooper Surgical for outstanding surgical video–  SELS Laparoscopic Myomectomy
 
Teaching Activities
<ul><li>TEACHING ACTIVITIES </li></ul><ul><li>Dr. Demir is a founding member of SELS </li></ul><ul><li>Society is dedicate...
<ul><li>TEACHING ACTIVITIES </li></ul><ul><li>Increase awareness of benefits of Minimally Invasive Surgical techniques in ...
<ul><li>TEACHING ACTIVITIES </li></ul><ul><li>Our First Annual Meeting will be held in October 2 - 3, 2011, at the Arizona...
SELS Homepage
Surgical Videos of the Society <ul><li>Log onto www.YouTube.com </li></ul><ul><li>Go to EliteLaparosccopic channel </li></...
 
<ul><li>TEACHING ACTIVITIES </li></ul><ul><li>Dr. Demir is a founding member of the Two Kilo Club </li></ul><ul><li>Site d...
Two Kilo Club Homepage
<ul><li>TEACHING ACTIVITIES </li></ul>The Two Kilo Club is an organization for the recognition of laparoscopic and minimal...
This list encompasses all surgeons who have successfully qualified to be counted among the ranks of the two kilo club by s...
<ul><li>Richard H. Demir, MD </li></ul>Thank you for viewing this summary of Dr. Demir <ul><li>This synopsis has included ...
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Dr.Demir Bio10 10

  1. 1. Richard H. Demir, MD Director of Ultrasound, Gynecology & Obstetrics - Desert Women’s Care President -Society of Elite Laparoscopic Surgeons
  2. 2. <ul><li>Richard H. Demir, MD </li></ul>This program summarizes key aspects of Dr. Demir’s ongoing activities <ul><li>This synopsis will include various activities, including: </li></ul><ul><li>Clinical </li></ul><ul><li>Administrative </li></ul><ul><li>Philanthropic </li></ul><ul><li>Publishing </li></ul><ul><li>Teaching </li></ul><ul><li>For additional information please refer to Dr. Demir’s Curriculum Vitae </li></ul>
  3. 3. Clinical Activities DWC… We care about patients!
  4. 4. Dr. Demir is proud of his commitment to Minimally Invasive Surgical principals and offers the most sophisticated procedures so open abdominal surgery can soon be relegated to history books DWC… We care about patients!
  5. 5. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>What drives the push toward Minimally Invasive Surgery across specialties? <ul><li>Similar or improved efficacy of new techniques </li></ul><ul><li>Less post procedure pain </li></ul><ul><li>Out patient care or shorter In-Patient stay </li></ul><ul><li>Decreased lost productivity in work place </li></ul><ul><li>Improved cosmetic result </li></ul><ul><li>Enhanced patient satisfaction </li></ul>
  6. 6. X
  7. 7. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>Gynecologists compared to other surgeons in adopting Minimally Invasive Techniques-- <ul><li>Slow to adopt Minimally Invasive Techniques </li></ul><ul><li>Not taught or harder to teach in residency </li></ul><ul><li>No financial reward for performing laparoscopic hysterectomy </li></ul><ul><li>Prohibitive learning curve </li></ul><ul><li>Patient referral issues at work in other specialties do not apply </li></ul><ul><li>Financial dis-incentive to refer to a minimally invasive surgeon </li></ul>
  8. 8. DWC Minimally Invasive Surgery Program
  9. 9. Dr. Demir and DWC offer a full team commitment to performing and successfully completing even the most complex procedures using Minimally Invasive techniques. DWC… We care about patients!
  10. 10. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>As the Director at DWC, Dr. Demir assures Minimally Invasive therapies are used to treat common Gynecologic problems for the benefit of our patients. Examples are provided for three common conditions: <ul><li>Pelvic Relaxation </li></ul><ul><li>Adnexal Masses </li></ul><ul><li>Abnormal Bleeding, Fibroids and Secondary Dysmenorrhea </li></ul>
  11. 11. X
  12. 12. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>PELVIC RELAXATION
  13. 13. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>Pelvic Relaxation <ul><li>Most often related to trauma to female pelvis from pregnancy and childbirth </li></ul><ul><li>Stress Urinary Incontinence and Cystocele </li></ul><ul><li>Progressive Pelvic Pain through day exacerbated by straining </li></ul><ul><li>Pelvic Organ prolapse including “dropping” of the uterus </li></ul><ul><li>Common solutions include Paravaginal repair or TOT </li></ul>
  14. 14. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>Anterior Compartment Defect with Stress Urinary Incontinence <ul><li>Laparoscopic Para-Vaginal Repair </li></ul><ul><li>Laparoscopic technique </li></ul><ul><li>30 to 60 minutes of operating time </li></ul><ul><li>Out patient </li></ul><ul><li>Discomfort consistent with laparoscopy </li></ul>
  15. 15. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>Anterior Compartment Defect with Stress Urinary Incontinence <ul><li>Laparoscopic Paravaginal Repair </li></ul><ul><li>Laparoscopic approach with three incisions </li></ul><ul><li>Thirty minutes of surgical time </li></ul><ul><li>Out-patient procedure </li></ul><ul><li>Back to work in a week </li></ul>
  16. 16. <ul><li>Laparoscopic Paravaginal Repair </li></ul><ul><li>In photo 1 the bladder is filled and anterior margin identified </li></ul><ul><li>In photo 2 and 3 the anterior parietal peritoneum is entered and Space if Retzius is dissected </li></ul>Photo 1 Photo 2 Photo 3
  17. 17. urethra bladder Dome of the Foley catheter Sutures suspend paravaginal tissue
  18. 19. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>Anterior Compartment Defect with Stress Urinary Incontinence <ul><li>Trans-Obturator Tape Procedure or TOT </li></ul><ul><li>Perineal approach </li></ul><ul><li>Two punctiform incisions and a single 2 cm vaginal incision </li></ul><ul><li>Regional block or general </li></ul><ul><li>15 to 20 minutes of operating time </li></ul><ul><li>Out patient </li></ul>
  19. 21. Uretex® TO Trans-Obturator Urethral Support System Twenty Minute Repair for Stress Urinary Incontinence
  20. 22. TransObturator Approach as effective as open abdominal surgery with 1 – 2 day recovery time and virtually no time off work Enquire… your physician has no idea that you may have Stress Incontinence
  21. 23. X
  22. 24. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>ADNEXAL PATHOLOGY & FIBROIDS
  23. 25. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>Adnexal Masses and Fibroids can be treated without resorting to laparotomy <ul><li>An example of Laparoscopic Myomectomy is presented </li></ul><ul><li>Laparoscopic approach is done as an out-patient </li></ul><ul><li>A morcellator is used to remove large masses through little holes </li></ul><ul><li>Two to three day recovery for most patients at home prior to returning to work or normal activities </li></ul>
  24. 26. Pedunculated sub-serosal uterine myoma is clearly demonstrated at laparoscopy
  25. 27. Myoma is attached to the uterus on a stalk that is clearly identified
  26. 28. Once free within the abdominal cavity the myoma is morcellated and removed in long fragments
  27. 29. Excision of this myoma leaves a denuded area that is covered with an anti-adhesive barrier prior to concluding the procedure
  28. 30. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>Benign Ovarian Tumors can also be removed laparoscopically <ul><li>Adnexal Mass not suspicious for ovarian neoplasm can be safely removed using Minimally Invasive Surgery. Criteria include: </li></ul><ul><li>CA125 < 200 U/ml </li></ul><ul><li>No ascites </li></ul><ul><li>No evidence of metastatic disease (abdominal or distant) </li></ul><ul><li>No 1 st degree relatives with ovarian or breast malignancy </li></ul><ul><li>ACOG Committee Opinion Number 280, December, 2002 </li></ul>
  29. 31. Ultrasound demonstrates an abnormal mass within the ovary
  30. 32. The same mass is demonstrated on laparoscopy
  31. 33. Mass is removed and bleeding controlled Capsule is opened and mass shelled out Capsule of ovary is closed with absorbable sutures
  32. 34. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>Benign Ovarian Tumors <ul><li>The abnormal tissue is removed from the ovary first by opening the capsule then by shelling it out. The normal ovarian capsule is then over-sewn. Benefits of this approach include: </li></ul><ul><li>Small “pencil like” incisions as opposed to a “bikini” scar </li></ul><ul><li>Return to work in a day or two </li></ul><ul><li>Decreased likelihood of scarring in the abdomen </li></ul>
  33. 36. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>HYSTERECTOMY & ALTERNATIVES
  34. 37. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>HYSTERECTOMY <ul><li>Most Common Benign Indications </li></ul><ul><li>Abnormal bleeding </li></ul><ul><li>Pain and secondary dysmenorrhea </li></ul><ul><li>Compression from large myomas </li></ul><ul><li>Prolapse / Pelvic Relaxation </li></ul><ul><li>Endometriosis </li></ul>
  35. 38. X
  36. 39. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>TRADITIONAL HYSTERECTOMY <ul><li>Total Abdominal Hysterectomy </li></ul><ul><li>Significant incision with cosmetic implications </li></ul><ul><li>Four to five days post-operative hospital stay </li></ul><ul><li>Significant post-operative pain </li></ul><ul><li>Four to six weeks recovery and time off of work and activities </li></ul>
  37. 40. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>HYSTERECTOMY ALTERNATIVE <ul><li>Embolization performed by Interventional Radiologist </li></ul><ul><li>Post-Op pain secondary to infarction of muscle </li></ul><ul><li>Potential uterine rupture if pregnancy follows </li></ul><ul><li>High probability of eventual hysterectomy with recurrence of myomas (myomas tend to be multi-focal and recurrent) </li></ul><ul><li>Menses continue </li></ul>
  38. 41. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>HYSTERECTOMY ALTERNATIVE <ul><li>Endometrial Ablation </li></ul><ul><li>Objectionable discharge for several weeks post procedure </li></ul><ul><li>Potential for endometritis </li></ul><ul><li>Must be sterilized to be a candidate </li></ul><ul><li>Must have normal uterine cavity & benign endometrium </li></ul><ul><li>Low probability of Secondary Amenorrhea: 26% in Gynecare Literature </li></ul>
  39. 43. TM *Based on Intent-To-Treat population 1. Extirpated uteri data on file, ETHICON, INC. 2. Loffer FD, Grainger D. Five-year follow-up of patients participating in a randomized trial of uterine balloon therapy versus rollerball ablation for treatment of menorrhagia. J AM Assoc Gynecol Laparosc. 2002;9(4):429-435. 3. NovaSure. Instructions for Use © 2004, Cytyc Corporation 4. Cooper J, Gimpelson R, Laberge P, et al. A randomized, multicenter trial of safety and efficacy of the NovaSure system in the treatment of menorrhagia . J Am Assoc Gynecol Laparosc . 2002;9:418-428. 5. GYNECARE THERMACHOICE ® III. Instructions for Use. © 2008 ETHICON, INC. 6. Her Option ® . Instructions for Use. © 2006 American Medical Systems, Inc. 7. Hydro ThermAblator ® System. Instructions for Use. © 2005 Boston Scientific Corporation. 4 5 6 of menstrual bleeding or lower has a conforming balloon which leads to improved coverage, treatment and efficacy vs earlier generation GYNECARE THERMACHOICE® products 1 is introduced, providing a silicone balloon material and fluid circulation the first GEA device, is introduced 4
  40. 44. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>HYSTERECTOMY ALTERNATIVE <ul><li>Endometrial Ablation </li></ul><ul><li>Low secondary amenorrhea rate </li></ul><ul><li>Need to be sterilized </li></ul><ul><li>---Combination Thermachoice & essure require HSG in 3 months </li></ul><ul><li>---Combnation Thermachoice and Scope TL comes with scope risks </li></ul><ul><li>Must have concordance of pre-op expectation with post-op reality to assure patient satisfaction </li></ul>
  41. 45. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>LAPAROSCOPIC HYSTERECTOMY <ul><li>Laparoscopic Hysterectomy-- SupraCervical or Complete </li></ul><ul><li>100% guarantee of no further vaginal bleeding post-recovery </li></ul><ul><li>Return to work within ten to fourteen days in most cases </li></ul><ul><li>No unsightly abdominal scar </li></ul><ul><li>Fewer incisions than with Robotic approach </li></ul><ul><li>Technique capable of treating even the largest fibroids with DWC Surgeons having removed up to 7 pound uterus in 2007 </li></ul>
  42. 46. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>LAPAROSCOPIC HYSTERECTOMY <ul><li>Supra-Cervical Hysterectomy </li></ul><ul><li>100% guarantee of no further vaginal bleeding post-recovery </li></ul><ul><li>Return to work within ten to fourteen days in most cases </li></ul><ul><li>Theoretic maintenance of pelvic support of cervix by conserving attachment of utero-sacral and cardinal ligaments </li></ul><ul><li>Eliminates incidence of cuff cellulitis by not opening the vagina </li></ul>
  43. 47. Ultrasound demonstrates a large fibroid tumor within the myometrium
  44. 48. Laparoscopy clearly demonstrates the enlarged uterus with irregularity of the fundus
  45. 49. Ligasure device is used to divide the attachments of the uterus
  46. 50. The bladder is located and moved out of the way to assure it is not injured
  47. 51. In Supra-cervical hysterectomy, the corpus is divided from the cervical stump
  48. 52. Once the body of the uterus is free, it must be morcellated so that it can be removed through the “pencil-like” abdominal incisions
  49. 53. The parietal peritoneum is sewn over the cervical stump sealing the abdominal cavity
  50. 54. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>LAPAROSCOPIC HYSTERECTOMY <ul><li>Complete Laparoscopic Hysterectomy </li></ul><ul><li>Patient preference for no future Cervical Cytology </li></ul><ul><li>Prior history or current cervical disease </li></ul>
  51. 55. Koh Colpotimizer Rumi Manipulator
  52. 59. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>COMPLETE LAPAROSCOPIC HYSTERECTOMY Once the uterus is free within the abdominal-pelvic cavity it can be removed in a variety of ways: --in one piece through the vagina --morcellated through the vagina --morcellated laparoscopically The vagina may be closed transvaginally or laparoscopically
  53. 60. <ul><li>In this case, the uterus was morcellated and the vaginal barrel is closed </li></ul><ul><li>with a suturing device called “endo-stitch.” </li></ul><ul><li>The second photo shows the closed vagina </li></ul><ul><li>The parietal peritoneum is then closed over this area in the usual manner </li></ul>
  54. 61. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>MINIMALLY INVASIVE HYSTERECTOMY ACOG and entire body of available literature concur-- Recognized superiority of minimally invasive hysterectomy, whether vaginal or laparoscopic, over traditional total abdominal hysterectomy with faster recovery, less post-operative pain, improved cosmetic appearance and similar complication rates. ACOG Committee Opinion 388, November 2007 So… every hysterectomy should be MIS, Right?
  55. 62. Early decrease from Scope Hyst (LH) Early increase from Scope Hyst (LH) Late decrease from Scope Hyst (LH)
  56. 63. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>So why are most hysterectomies not done using MIS techniques? <ul><li>Increased uterine size </li></ul><ul><li>Elevated patient BMI </li></ul><ul><li>Previous abdominal surgeries / prior C - Sections </li></ul><ul><li>Complicating medical conditions </li></ul><ul><li>Surgeon’s experience </li></ul>Traditional exclusion criteria are dealt with at DWC. DWC Offers Total Team Commitment to MIS hysterectomy
  57. 64. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>GUINNESS WORLD RECORD DWC <ul><li>Awarded November 30, 2008, for a surgery in October, 2007 </li></ul><ul><li>3200 grams uterus removed without resorting to laparotomy </li></ul><ul><li>Patient back to work in two weeks </li></ul><ul><li>Co-surgeon, Greg Marchand, MD </li></ul><ul><li>Technique of Extended Hysterectomy employed </li></ul>Should increased uterine size disqualify?
  58. 67. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>LAPAROSCOPIC HYSTERECTOMY AT DWC <ul><li>Demonstrated history of accomplishment at DWC </li></ul><ul><li>Of our last 547 Hysterectomy cases attempted for benign indications (excluding cases of invasive carcinoma) 542 cases successfully completed laparoscopically with overall success rate of 99.08% </li></ul><ul><li>Our series includes large uteri, elevated BMI, scarred abdomen, etc. </li></ul><ul><li>(7 pound uterus, 350 pound patient, 5 prior CS) </li></ul>
  59. 69. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>With Minimally Invasive Techniques DWC reliably offers-- <ul><li>Similar or improved efficacy of new techniques </li></ul><ul><li>Less post procedure pain </li></ul><ul><li>Out patient care or shorter In-Patient stay </li></ul><ul><li>Decreased lost productivity in work place </li></ul><ul><li>Improved cosmetic result </li></ul><ul><li>Enhanced patient satisfaction </li></ul><ul><li>And,,,, high actual completion rate </li></ul>
  60. 70. Anybody need some help here?
  61. 71. <ul><li>MINIMALLY INVASIVE SURGERY </li></ul><ul><li>AT DESERT WOMEN’S CARE </li></ul>When compared with Robotics, DWC’s Minimally Invasive Techniques reliably offer-- <ul><li>Reduced operating time </li></ul><ul><li>Less time under general anesthesia </li></ul><ul><li>Fewer abdominal incisions (three or four as opposed to five with </li></ul><ul><li>the DaVinci Robot) </li></ul><ul><li>Markedly lower cost </li></ul>
  62. 72. DWC Multidisciplinary Pelvic Pain Program
  63. 73. <ul><li>CENTER FOR PELVIC PAIN </li></ul><ul><li>AT DESERT WOMEN’S CENTER </li></ul><ul><li>Multidisciplinary care for women suffering from chronic pelvic pain: </li></ul><ul><li>--undiagnosed pain --urethral syndrome </li></ul><ul><li>--unresponsive pain --trigonitis </li></ul><ul><li>--endometriosis --nephrolithiasis </li></ul><ul><li>--interstitial cystitis --hernias </li></ul><ul><li>--pelvic adhesions --myofascial dysfunction </li></ul><ul><li>--uterine retroversion --degenerative disc disease </li></ul><ul><li>--irritable bowel syndrome --scoliosis </li></ul><ul><li>--inflammatory bowel disease --nerve entrapment </li></ul><ul><li>--diverticular disease --arthritis </li></ul><ul><li>--depression --auto-immune disorders </li></ul>
  64. 74. <ul><li>CENTER FOR PELVIC PAIN </li></ul><ul><li>AT DESERT WOMEN’S CENTER </li></ul>Gynecology Gastroenterology Pain Management Neurology Psychiatry
  65. 75. <ul><li>CENTER FOR PELVIC PAIN </li></ul><ul><li>AT DESERT WOMEN’S CENTER </li></ul><ul><li>BENEFITS TO THIS TYPE OF PROGRAM </li></ul><ul><li>Prevents dead-end transfers </li></ul><ul><li>Prevents unnecessary surgical interventions </li></ul><ul><li>Decreases habituation to narcotic analgesics </li></ul><ul><li>More expeditious: quicker time from entry to relief </li></ul><ul><li>Immediate recognition of psychiatric implications </li></ul>
  66. 76. <ul><li>CENTER FOR PELVIC PAIN </li></ul><ul><li>AT DESERT WOMEN’S CENTER </li></ul><ul><li>Multidisciplinary care for women suffering from chronic pelvic pain: </li></ul><ul><li>GYNECOLOGY Conditions- 70% of cases: </li></ul><ul><li>dysmenorrhea </li></ul><ul><li>infection </li></ul><ul><li>cycts </li></ul><ul><li>myomas </li></ul><ul><li>polyps </li></ul><ul><li>prior surgeries / adhesions </li></ul><ul><li>endometriosis </li></ul><ul><li>endosalpingiosis </li></ul><ul><li>adenomyosis </li></ul><ul><li>pelvic congestion </li></ul>
  67. 77. <ul><li>CENTER FOR PELVIC PAIN </li></ul><ul><li>AT DESERT WOMEN’S CENTER </li></ul><ul><li>Multidisciplinary care for women suffering from chronic pelvic pain: </li></ul><ul><li>GYN UROLOGY Conditions- 5% of cases: </li></ul><ul><li>urethral syndrome </li></ul><ul><li>trigonitis </li></ul><ul><li>interstitial cystitis </li></ul><ul><li>peritoneal endometriosis overlying urinary tract </li></ul><ul><li>bladder endometriosis </li></ul>
  68. 78. <ul><li>CENTER FOR PELVIC PAIN </li></ul><ul><li>AT DESERT WOMEN’S CENTER </li></ul><ul><li>Multidisciplinary care for women suffering from chronic pelvic pain: </li></ul><ul><li>GASTROENTEROLOGY Conditions- 10% of cases: </li></ul><ul><li>irritable bowel syndrome </li></ul><ul><li>inflammatory bowel disease </li></ul><ul><li>diverticular disease </li></ul><ul><li>chronic appendicitis </li></ul><ul><li>adhesions </li></ul><ul><li>bowel endometriosis </li></ul>
  69. 79. <ul><li>CENTER FOR PELVIC PAIN </li></ul><ul><li>AT DESERT WOMEN’S CENTER </li></ul><ul><li>Multidisciplinary care for women suffering from chronic pelvic pain: </li></ul><ul><li>NEUROLOGY (Musculoskeletal) and Pain Management Conditions- 15% of cases: </li></ul><ul><li>hernias (incisional, inguinal, femoral, sciatic and ventral) </li></ul><ul><li>fasciitis </li></ul><ul><li>nerve entrapment </li></ul><ul><li>fascial tears </li></ul><ul><li>myofascial dysfunction </li></ul><ul><li>scoliosis </li></ul><ul><li>degenerative disc disease </li></ul><ul><li>pelvic trauma </li></ul><ul><li>trigger points </li></ul>
  70. 80. <ul><li>CENTER FOR PELVIC PAIN </li></ul><ul><li>AT DESERT WOMEN’S CENTER </li></ul><ul><li>Multidisciplinary care for women suffering from chronic pelvic pain: </li></ul><ul><li>PSYCHIATRIC Conditions- 80% of cases </li></ul><ul><li>Depression causing pain </li></ul><ul><li>Pain causing Depression </li></ul>
  71. 81. <ul><li>CENTER FOR PELVIC PAIN </li></ul><ul><li>AT DESERT WOMEN’S CENTER </li></ul><ul><li>WHY WE ARE DIFFERENT </li></ul><ul><li>Unified laboratory and imaging evaluation available to each team member </li></ul><ul><li>Patient seen by each specialist with specific additional work-up as deemed necessary </li></ul><ul><li>Regular meetings of team to discuss cases and develop integrated treatment plans </li></ul><ul><li>Shorter time to diagnosis minimizing reliance on narcotic analgesics </li></ul><ul><li>Early recognition and treatment of psychiatric aspects in chronic pain sufferers </li></ul>
  72. 82. X
  73. 83. Administrative Activities DWC… We care about patients!
  74. 84. <ul><li>ADMINISTRATIVE ACTIVITIES </li></ul>Dr. Demir is Medical Director at DWC Dr. Demir has held various administrative positions in Maternal - Child Health services over the last twenty years. In addition to his clinical role in OB/GYN he has developed and directed services in Assisted Reproduction / IVF, Maternal - Fetal Medicine, General Pediatrics, Sub-Specialty Pediatrics, Family Practice, Internal Medicine, General Surgery and Laboratory.
  75. 85. <ul><li>ADMINISTRATIVE ACTIVITIES </li></ul><ul><li>Management physicians & mid-level providers </li></ul><ul><li>Strategic planning and development of sub-specialty services: </li></ul><ul><li>Maternal – Fetal Medicine </li></ul><ul><li>Gynecologic ONC </li></ul><ul><li>Laboratory </li></ul><ul><li>Marketing </li></ul><ul><li>Development of Clinical Practice Guidelines and modeling of provider adherence to published principals of care </li></ul><ul><li>Directs Quality Assurance, Utilization Review and Satisfaction Assessment functions at group </li></ul>Dr. Demir is Director of Gynecology, Obstetrics and Ultrasound at DWC
  76. 86. <ul><li>ADMINISTRATIVE ACTIVITIES </li></ul><ul><li>Insurance companies have long used actuaries, attorneys, business men and physicians to develop algorithms to deny care to patients and to assure that the lowest cost guidelines are implemented </li></ul><ul><li>Dr. Demir has developed Clinical Practice Guidelines to assure that appropriate care is always offered to DWC patients </li></ul><ul><li>Clinical Practice Guidelines are developed to assure appropriate resources are committed to patient’s problems and revenues at DWC are enhanced </li></ul>Clinical Practice Guidelines
  77. 87. X
  78. 88. <ul><li>ADMINISTRATIVE ACTIVITIES </li></ul><ul><li>Patient care must be viewed in its totality to assure that all aspects are maximized </li></ul><ul><li>Variables such as cost reduction, revenue enhance, risk avoidance and patient satisfaction have to be quantified for all disease states, risks and benefits weighed and appropriate management must be determined </li></ul><ul><li>Through such an analysis outcomes can be maximized </li></ul>Clinical Practice Guidelines
  79. 89. X
  80. 91. A full website is up and running for Desert Women’s Care. Communication with patients featuring text, photos and videos is available online. DWC… We care about patients!
  81. 92. X
  82. 93. <ul><li>Philanthropic Activities </li></ul><ul><li>Demir Foundation </li></ul>
  83. 94. <ul><li>Demir Foundation </li></ul><ul><li>Demir Foundation was responsible for administering more than $2.5 million in immunizations to children of the working poor in the Chicago area’s North West suburbs </li></ul><ul><li>Demir Medical Group through its Pediatric branch oversaw the program and contributed substantially to the community </li></ul>
  84. 96. <ul><li>Demir Foundation </li></ul><ul><li>Demir Foundation also contributed to the beautification of the Elgin area with two works of civic sculpture </li></ul><ul><li>Artist David Powers was the creative force behind both works </li></ul>
  85. 97. X
  86. 98. The “Raise The Flag” project returned the US flag to walton Island on the Fox River in Elgin
  87. 99. <ul><li>Demir Foundation </li></ul><ul><li>“ Seven at the Gates of Dawn” located at the Foundation’s park symbolized the efforts of the Group’s philanthropic efforts on behalf of the Women and Children of the greater Elgin area </li></ul>
  88. 100. X <ul><li>“ Seven at the Gates of Dawn” </li></ul><ul><li>Elgin Image Award, 1998 </li></ul><ul><li>Elgin Cultural Arts Commission Award, 1998 </li></ul>
  89. 101. <ul><li>Demir Foundation </li></ul><ul><li>Dr. Demir continues to be proud of the Foundation’s work and the legacy of beautification provided by its civic art donations. </li></ul>
  90. 102. <ul><li>Raise The Flag Project </li></ul><ul><li>Flag Day Dedication, June 14, 2002 </li></ul><ul><li>Elgin Image Award Nominee, 2003 </li></ul>
  91. 103. Publishing DWC… We care about patients!
  92. 104. Dr. Demir has over twenty peer-reviewed publications including articles, abstracts, videos and book chapters. DWC… We care about patients!
  93. 105. “ Laparoscopic Cervical Cerclage in 18 weeks Pregnant Uterus” was presented in June, 2010, at BICOG in Belfast, UK, and in September at SLS in New York City DWC… We care about patients!
  94. 106. Dr. Demir and Dr. Marchand won Honorable Mention GYN Video Award at 2010 Annual Meeting of Society of Laparoendoscopic Surgeons in New York City
  95. 107. Dr. Demir won 2010 Spotlight Award from Cooper Surgical for outstanding surgical video– SELS Laparoscopic Myomectomy
  96. 109. Teaching Activities
  97. 110. <ul><li>TEACHING ACTIVITIES </li></ul><ul><li>Dr. Demir is a founding member of SELS </li></ul><ul><li>Society is dedicated to the advancement and increased availability of Minimally Invasive Surgery in Gynecology </li></ul><ul><li>Membership is growing to include leaders in Minimally Invasive Gynecologic Surgery around the world </li></ul><ul><li>Accessing the SELS website puts prospective patients in touch with capable surgeons in their own region capable of offering Minimally </li></ul><ul><li>invasive Gynecologic Surgery </li></ul>SELS
  98. 111. <ul><li>TEACHING ACTIVITIES </li></ul><ul><li>Increase awareness of benefits of Minimally Invasive Surgical techniques in the general patient population </li></ul><ul><li>Increase physician awareness of benefits of Minimally Invasive Surgical techniques </li></ul><ul><li>Increase availability of Minimally Invasive Surgical procedures to patients world wide </li></ul><ul><li>Increase compensation to physicians by insurance companies who spend the additional time and accept the heightened risks of performing Minimally Invasive Surgical procedures </li></ul>SELS PLATFORM
  99. 112. <ul><li>TEACHING ACTIVITIES </li></ul><ul><li>Our First Annual Meeting will be held in October 2 - 3, 2011, at the Arizona Biltmore Resort </li></ul><ul><li>Members and Guests will enjoy a two day scientific program </li></ul>SELS CONFERENCE
  100. 113. SELS Homepage
  101. 114. Surgical Videos of the Society <ul><li>Log onto www.YouTube.com </li></ul><ul><li>Go to EliteLaparosccopic channel </li></ul><ul><li>28,000 views in its first year of operations </li></ul><ul><li>Teaching videos on numerous gynecological surgeries </li></ul>
  102. 116. <ul><li>TEACHING ACTIVITIES </li></ul><ul><li>Dr. Demir is a founding member of the Two Kilo Club </li></ul><ul><li>Site dedicated to recognizing excellence in the practice of Minimally Invasive Gynecologic Surgery </li></ul><ul><li>Members must have removed at least a 2000 gram fibroid without resorting to use of laparotomy or “hand assisted” laparoscopic techniques </li></ul>Two Kilo Club
  103. 117. Two Kilo Club Homepage
  104. 118. <ul><li>TEACHING ACTIVITIES </li></ul>The Two Kilo Club is an organization for the recognition of laparoscopic and minimally invasive skills and achievements, especially those that were previously thought to be &quot;impossible.&quot; We recognize that difficult laparoscopic and minimally invasive surgery is not based solely on the size of the uterus, and that one particular surgical feat does not prove any particular surgeon to be especially adept. However, the Two Kilogram uterus is a significant challenge whether by vaginal or laparoscopic approach.  Accordingly we use this as our standard and invite gynecologic surgeons to this challenge.  We recognize the successful with membership and praise. Two Kilo Club
  105. 119. This list encompasses all surgeons who have successfully qualified to be counted among the ranks of the two kilo club by successfully removing a uterus weighing greater than 1999 grams without resorting to laparotomy.  Member list is updated monthly.  Surgeons may apply by submitting official documentation in order to be considered immediately.  In addition, TKC staff performs regular literature searches of reliable sources and data collection agencies in order to attempt to compile a comprehensive list of all surgeons internationally who have accomplished this feat. Two Kilo Club
  106. 120. <ul><li>Richard H. Demir, MD </li></ul>Thank you for viewing this summary of Dr. Demir <ul><li>This synopsis has included various activities, including: </li></ul><ul><li>Clinical </li></ul><ul><li>Administrative </li></ul><ul><li>Philanthropic </li></ul><ul><li>Publishing </li></ul><ul><li>Teaching </li></ul><ul><li>For additional information please refer to Dr. Demir’s Curriculum Vitae </li></ul>
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